Condition-Related Factors
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.
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adults should be aware of the effects of depression on adherence, and should evaluate older adults who appear sad or withdrawn or have unexplained physical complaints or sleeping problems to identify or rule out clinical depression (National Advisory Council on Aging, 2002).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).
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Lack of knowledge regarding nature of depression
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Discuss depression as a common, treatable condition
Refer to depression as a medical condition
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Guilt associated with diagnosis of depression
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Discuss chemical basis for depression
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Need for reassurance and support
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Reinforce that depression is treatable
Discuss appropriate duration of treatment
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Lack of belief in treatment’s effectiveness
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Discuss efficacy of medications
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Belief that treatment does not help with symptoms associated with depression
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Discuss delayed onset of therapeutic effects of antidepressants
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Fear of side effects
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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
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"Felt better" and stopped taking medication
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Discuss the importance of an adequate duration of therapy and risk of relapse
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Source: Bucci et al., 2003