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Since the recommendations by the Agency for Health Care Policy and Research (AHCPR) and the American Psychiatric Association include antidepressant therapy for at least four to nine months, adherence is critical to prevent a relapse of depression. Continuing antidepressant therapy was shown to decrease the risk of relapse by 70%.63

In addition, the likelihood of non-adherence to antidepressant therapy may also be seen in the medications for other chronic diseases that may co-occur. Depression is associated with medication non-adherence in outpatients with coronary heart disease (CHD), contributing to adverse cardiovascular outcomes.64

Non-adherence by individuals with a low level of depressive symptomatology is associated with non-adherence to important aspects of diabetes self-care. Interventions aimed at alleviating depressive symptoms could result in significant improvements in diabetes self-care.65

Barriers to medication adherence in individuals with depression are many. The misunderstanding of mental illness and associated stigma prevent many from seeking professional help. Often an individual may go for weeks or months incapacitated.3 These feelings are clearly one of the factors associated with a lack of medication adherence.

Medication-related factors that have been identified as potential barriers to medication adherence include the following:

  • Increasing number of daily doses and concurrent medications, especially with co-morbidity present

  • Long-term therapy; length of psychiatric history

  • Slow onset of efficacy

  • Adverse effects even though most disappear in a short time

    • Weight gain

    • Sexual dysfunction

    • Fatigue

    • Dizziness

Patient-related factors that have been identified as potential barriers to medication adherence include the following:

  • Substance abuse

  • Poor memory, which may be a consequence of the medication or the disease

  • Varying ages of patients with depression

  • Stigma of taking medications for a mental illness

  • Poor social support

  • Depression related concentration and organization processing

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