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Depression and psychiatric disorders are associated with poor medication adherence (Krueger et al., 2005). This discussion will be limited to depression and psychosis, and medication adherence issues associated with these conditions.

DEPRESSION

photo Studies show that persons with chronic illnesses who are depressed have significantly lower rates of medication adherence (Krueger et al, 2005, Appendix A). Professionals working with older adults should be aware of the effects of depression on adherence, and should evaluate older adults who appear sad or withdrawn or have unexplained physical complaints or sleeping problems to identify or rule out clinical depression (National Advisory Council on Aging, 2002).

For older adults receiving medications to treat depression, one factor that may decrease adherence is the delayed onset of action of antidepressants, which may take four weeks or longer to exert effects. Side effects are most likely to occur early in therapy, therefore the person may experience side effects prior to the relief of symptoms, which can lead to early discontinuation of therapy (Keller et al., 2002). Some people may discontinue antidepressant therapy once they begin to "feel better" (Demyttenaere, 2003). People who prematurely discontinue antidepressant therapy are at greater risk for relapse (Geddes et al., 2003).


BARRIER STRATEGIES
Lack of knowledge regarding nature of depression
Discuss depression as a common, treatable condition
Refer to depression as a medical condition
Guilt associated with diagnosis of depression
Discuss chemical basis for depression
Need for reassurance and support
Reinforce that depression is treatable
Discuss appropriate duration of treatment
Lack of belief in treatmentís effectiveness
Discuss efficacy of medications
Belief that treatment does not help with symptoms associated with depression
Discuss delayed onset of therapeutic effects of antidepressants
Fear of side effects
Review most common side effects
Reinforce that most people do not have to stop therapy because of side effects
Reassure person that over time side effects should be less of a problem
"Felt better" and stopped taking medication
Discuss the importance of an adequate duration of therapy and risk of relapse

Source: Bucci et al., 2003