Expert panelists consider factors affecting treatment adherence for patients with MDD.
Jay Weaver, PharmD, MPH: One of the especially troublesome adverse effects from our core therapy for MDD [major depressive disorder], SSRIs [selective serotonin reuptake inhibitors], and SNRIs [serotonin-norepinephrine reuptake inhibitors], are sexual adverse effects. These affect joy in their life or a connection point with a partner. We’re giving them therapy that in many cases may impede that. That’s a challenge. That’s 1 piece.
Another finer point is that even as people begin to understand that these treatments take a long time to work, we find that there’s a background rate of inefficacy among many therapies, such that by waiting 8 or 12 weeks or beyond, the therapy isn’t doing much good. People tend to abandon a therapy that isn’t working for them, especially in the face of those adverse effects we spoke of. There are a number of challenges in this space. Fortunately, some of the therapies are affordable. They’re inexpensive. As we move to newer generations, some of the older therapies are much more costly, but there are affordable therapies. But oftentimes, people need to go through several therapies to find one that works for them and that they can tolerate. It isn’t an easy disease to treat and to titrate for.
Mona Chitre, PharmD, CGP: Treatment adherence is basically taking a medication as prescribed by your health care provider for the duration of time. In the mental health space, specifically in MDD, treatment adherence is so important because it takes 6 to 8 weeks for a medication to work. In that time, before the medication works, often patients experience adverse effects. They can include weight gain, weight loss, and fatigue. It can feel like worsening of your MDD symptoms.
It’s important to talk with your provider and pharmacist about what you’re experiencing. Will the adverse effects go away with time? Many will. Will adverse effects require a change in medication or a change in dose? Adherence in MDD is critically important. Some of the challenges of adherence are balancing safety and effectiveness. The nice thing is there are many treatment options available. We can take the time to tailor the right medication to the right patient. Then there are other barriers that we see commonly: the price of medications, remembering to take the medication, access to medications, and access to follow-up. Adherence is critically important to MDD because this is a symptomatic condition, and with adherence, we can help the health and well-being of our patients and members.
Transcript edited for clarity.