Dr Paul Ciechanowski Explains the Impact of Depression on Medication Adherence

There have been many studies proving that depression interferes with medication adherence, but it isn't enough to just treat depression to get better outcomes, providers have to hand hold patients and help them improve their motivation to start taking medications again, explained Paul Ciechanowski, MD, MPH, associate professor at the University of Washington.

Transcript (slightly modified for readability)

How often does depression serve as a barrier to good medication adherence?

As far as depression being a barrier, when a person is depressed, first of all they feel sluggish, low energy, low motivation, they have problems concentrating, they get easily overwhelmed, and frankly a lot of times they're just saying, "What's the use?" Their motivation just goes out the window. And sometimes depressed people have suicidal thoughts, or they're just passively suicidal, and they're just thinking "Why do I even need to take these medications? I don't even feel like living."

So just thinking about that at a clinical level, that's a huge barrier to people taking any kind of treatment. What we know from our studies, when we look at depressed people at Group Healt Cooperative [in Seattle, Washington], for example, who are in the top tertile of depression compared to the bottom tertile, the difference was double: 14% had lapses in their medications if we looked at pharmacy data, compared to 7%. In another study that we did, we looked at lipid-lowering agents and among people who were depressed they had 50% more nonadherence. Among people taking ACE [angiotensin-converting-enzyme] inhibitors they were 33% more likely to be nonadherence if they were depressed.

So we've seen this over and over and any clinician will say "Yeah, no kidding, depression gets in the way." At every level it affects patients, and that's why we need to really aggressively treat depression, but what we've discovered in our trials is it's not just enough to treat depression to get better outcomes, you also have to hand hold and help patients be convinced and improve their motivation once the depression starts to go away to get them to start taking their medications again.