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The Importance of Compliance in the Treatment of Depression

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While depression is one of the most common behavioral health conditions affecting adults, it is also one of the most treatable. There are currently a number of medications that help people manage the symptoms of depression in addition to effective psychotherapy and counseling procedures for this condition. Surprisingly, one of the major problems in treating depression is related to patients not following through with treatment recommendations made by their doctor or clinician.

One national health care accrediting organization (NCQA)* annually reports the percentage of patients who see a doctor or clinician for follow-up care for depression and the percentage of times that patients continuously fill prescriptions for antidepressant medications. While there is some variability, across a number different health plans in the United States, only 18-20% of patients who were diagnosed with depression had as many as three follow-up visits with a doctor or clinician in the twelve weeks following the diagnosis. Only 50-60% of patients who are given antidepressant continuously refill their prescription for the next twelve weeks. Clearly, not everyone diagnosed with depression is receiving consistent care or taking the medications as prescribed. For patients who are receiving psychotherapy it is equally important to follow through with the recommended duration and intensity of treatment.

Following the treatment recommendations made by the Doctor/Clinician is referred to as "treatment compliance." If you are being treated for depression it is crucial that follow the treatment recommendations made by your doctor or your clinician. Both medications and psychotherapy are effective treatments for depression. However, they are only effective if patients follow the recommended treatment strategy as precisely as possible.

Compliance with Antidepressant Medications There are a number of different types of medicines currently available to treat depression. Your doctor will prescribe the one that he or she thinks will help you the most, based on your symptoms and situation. Regardless of the particular medication that you are taking it is important to follow the dosage and frequency directions precisely. One of the common problems reported by patients is that the medicine does not work as quickly as would be liked. Unfortunately, these medicines can take several weeks to work and the fact that you do not notice immediate change should not be discouraging. The second problem encountered by many patients is that once they feel less depressed they stop taking the medication, apparently believing that medicine is no longer needed. In fact, the medication should be taken for at least 6 to 9 months to ensure the optimal impact on depression. In this way, antidepressants are much like antibiotics — in order for an infection to go away and not return you have to take antibiotics for the entire course of treatment — not just until the pain has disappeared.

In summary, you must keep taking the antidepressant even though it does not appear to initially be working and you must continue taking the medication after you are feeling better. There are instances where the initial prescription does not work as it should. In this case, make sure that you tell your doctor that you are not experiencing the change that you are expecting. If this happens, your doctor will try a different antidepressant. Different antidepressants work differently with different people and your doctor is the best person to decide which medication is most likely to be effective in your case. Try not to become discouraged if the first medicine you try does not work as you had hoped. It is important to keep your doctor informed as to how the medicine is working or not working.

Please see the article titled "Treating Depression with Antidepressant Medications" for more information.

Compliance with Psychotherapy Compliance with psychotherapy is equally important as it is with medications. However, treatment compliance with psychotherapy can be a bit more complex because there are not as many clear findings about therapy length and intensity as there are for medications. In addition, there are differing types of therapy that can lead to the same result. All therapies assume that some aspects of depression are learned responses to difficult life events and that patients must learn new ways of coping in order to become less depressed. Some forms of therapy (such as cognitive-behavioral therapy) emphasize the role of negative thoughts in depression and the importance of learning how to think differently about life events. In this type of therapy, patients are actively involved in identifying effective ways to deal with life problems and stresses. Problematic thinking styles are identified and patients are encouraged to learn and practice more effective ways of appraising and dealing with problems. This type of therapy assumes that patients can learn new and more positive ways of dealing with life regardless of what lead the person to become depressed. Some cognitive behavioral treatments make use of specific treatment manuals to guide the treatment process. Cognitive-behavioral therapy is mentioned because it has been shown to be effective with depression.

There are other ways to approach the treatment of depression that are also effective. When you meet with a therapist it is important to understand how the therapy works and what it means to be compliant with the treatment recommendations. Feel free to ask your clinician how the therapy works, how long it takes and what is expected of you in order for it to work. Just as with medications there may be a period of time where it does not appear that your depression is improving. This is normal. Just as with any skill, it takes time to learn new ways to respond to stressful situations. It is important to give the therapy a chance to work even if it seems like things are not immediately changing.

Some tips on helping your therapy for depression work:

  • Make sure that you understand the exact dosage and duration of prescribed medications
  • Take the medicine exactly as prescribed
  • Keep taking the medication even if it does not seem to work right away
  • Ask your doctor about possible side effects
  • Keep taking the medication for the entire time that it is prescribed — even if you are feeling better
  • When you are in psychotherapy, make sure you understand and have confidence in the approach taken by your clinician
  • Follow the recommendations for behavioral change made by your clinician
  • Even if you feel a bit uncomfortable at the beginning, give the process a chance
  • Recognize that learning new ways of managing your mood takes time
  • Ask questions about how therapy works and how long it lasts
  • Avoid using alcohol or other mood altering substances
  • Lead a balanced lifestyle with adequate sleep, exercise and a healthy diet

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Disclaimer: The information about educational or therapeutic approaches is provided for educational purposes only. Certain treatments may or may not be covered through your benefit plan. Coverage typically depends on your plan specifications and relevant guidelines maintained in relation to your benefit plan.

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