Depressed patients with chronic illnesses less likely to take medications
■ Noncompliance is a clue that depression could be the cause, a study finds.
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Family physician Martin Lipsky, MD, said many patients diagnosed with hypertension at his Rockford, Ill., practice don't take their medications properly. The reasons include their inability to afford drugs and reluctance to take drugs because of side effects.
A new study reminds doctors to consider depression as a possible explanation why patients with a chronic illness don't take their medicine as directed.
The study, published online May 1 in the Journal of General Internal Medicine, found that depressed patients with a chronic condition are less likely to comply with medication instructions than those who are not depressed. The reasons include a lack of motivation, feelings of hopelessness and changes in cognition, the study said.
"Adherence is a huge problem for chronic illness," Dr. Lipsky said. "Sometimes our clinicians under-recognize depression as [the reason for this issue]. This study reminds us that depression can be an important factor to consider."
The study's authors recommend that physicians periodically ask depressed patients if they are taking their medication the way it was prescribed. Doctors also should screen people for depression if it seems they are not taking medicine correctly.
One indication of nonadherence is when a patient's chronic condition is suddenly not well-controlled, said senior study author Walid F. Gellad, MD, MPH. He said physicians can check pharmacy records to see if patients filled their prescriptions.
Dr. Gellad said a depression screen can consist of a few quick questions about how the patient is eating and sleeping. For patients he knows well, he often asks about their moods and what is going on in their lives.
Noncompliance is a "clue that depression could be a problem, and doctors should inquire about it," said Dr. Gellad, a researcher at the RAND Corp. and an assistant professor of medicine at the University of Pittsburgh School of Medicine.
Three in four Americans do not take their medication as directed by a physician, according to the National Consumers League, which launched a campaign in May to improve prescription medication adherence. The league represents consumers and workers on marketplace and workplace issues.
Poor compliance is associated with increased death rates among people with chronic illnesses, the journal study said. Interventions to improve adherence, however, have not been successful due, in part, to a lack of understanding about the cause of the problem, the authors said.
Managing chronic conditions
Researchers examined 31 studies published between 1998 and April 2009 on depression and medication adherence for chronic diseases. The chronic conditions included hyperlipidemia/hypertension, diabetes, coronary heart disease and asthma. The analysis covered more than 18,000 patients.
Researchers found that depressed patients with chronic illnesses were 76% more likely to be nonadherent with their medications than people who were not depressed. The findings were based on patients' self-reported medication habits.
The link between depression and medication compliance was similar for all the chronic illnesses studied.
This "consistent link underscores the seriousness of the role that depression plays in keeping people from properly managing chronic conditions," said Jerry L. Grenard, PhD, lead study author and an assistant professor in the School of Community and Global Health at Claremont Graduate University in Claremont, Calif.
The study's findings come as primary care physicians increasingly are being asked to identify and treat individuals with mental illness. The influx in mental health patients is largely a result of the nation's shortage of mental health specialists.
Dr. Lipsky said discussing mental illnesses such as depression is time-consuming because the conditions are so complex. He said some physicians feel uncomfortable addressing these health issues because of their limited training on the subject and a lack of time during office visits.
"It's just challenging to do everything in a short amount of time," he said.