Choosing the Right Antidepressant

By Jane Farrell

Depression is a difficult condition to deal with – and choosing the right medicine can be almost as complicated.

There are a lot of choices today, but their effects may be unpredictable, according to the Mayo Clinic. As a result, the Mayo experts say, patients can spend months or even years looking for the right medication. And clinicians may be uneasy about offering options other than the medicines they usually work with.

However, a new study from Mayo shows that a simple series of conversation cards can dramatically improve both patient and physician satisfaction in the choice of the antidepressant.

The findings were published in the journal JAMA Internal Medicine.

“We worked closely with patients, their families, and clinicians to fully understand what really matters to them when confronted with this situation. We wanted to transform the too-often unavailable evidence into accurate, easily accessible information to be used within the context of each person’s needs and preferences, ultimately creating what we hope to be meaningful conversations,” says Annie LeBlanc, Ph.D., first author and Mayo Clinic health science researcher.

According to Mayo, the study looked at information from 117 physicians and 301 patients from a range of Minnesota and Wisconsin communities. When compared to their usual care, the use of decision aids improved patients’ comfort in making decisions by five out of 100 points.

At the same time, the aids improved patient knowledge by 10 out of 100 points. The likelihood of being satisfied increased by 2.4-fold, Mayo said.  Additionally, researchers said, physicians also reported an increase in decision-making comfort by 11 out of 100 points as well as a 1.6-fold increase in the likelihood of being satisfied. The extent to which they involved patients in the decision-making process increased by 16 out of 100 points. The use of the tool did not add to the length of the discussion between patient and physicians.

Patients often give up on a particular antidepressant because of unrealistic expectations, the ineffectiveness of treatment or undesirable side effects, Mayo says. And physicians, the clinic adds, often focus just on the drug’s efficacy rather than a patient’s needs and preferences.

The study didn’t come to a conclusion about the actual effectiveness of a medication, or adherence to taking it. But the researchers emphasized that improving the patient/physician process in choosing an antidepressant paves the way for more effectively treating depression in the future.

Though this study did not conclude a difference in effectiveness or adherence to medication, the researchers say that improving the process by which patients and clinicians select an antidepressant, and making both parties feel more comfortable in their medication choice, is a step toward more effectively treating depression in the future.

“High value healthcare involves aligning the care we give patients with their values, preferences, and life circumstances, alongside the best evidence available for that care,” explains LeBlanc. “This tool is but one way we can effectively approach the ideal of patient-centered care for patients with depression. And, with limited cost and burden to the system, this tool and its associated three minutes of training are available free online.”

For more information, visit Mayo Clinic’s Shared Decision Making Resource Center.