A comparison of factors used by physicians and patients in the selection of antidepressant agents

Objectives: Involving patients in treatment decisions may reduce premature antidepressant treatment terminations and improve clinical and health economic outcomes. However, a first step is to determine what information to provide to patients to facilitate their decision making. The authors therefore identified, valued, and ranked factors of antidepressant treatment selection that are relevant to patients and compared them with the opinions of general practitioners. Methods: Matching surveys were developed for patients and physicians with feedback from focus groups. In the patient group, participation was requested from consecutive patients at four family practice sites in Nova Scotia, Canada. Surveys were mailed to 247 randomly selected general practitioners. Results: Surveys were completed by 127 patients and 110 physicians, representing return rates of 70% and 46%, respectively. The most valued of the 12 differentiating factors when selecting an antidepressant, ranked first by both patients and physicians, was common side effects. Also ranked highly by both groups were precautions with antidepressant use, physician antidepressant experience, and discontinuation problems. Groups differed in their ranking of uncommon serious side effects, time since antidepressants were marketed, cost, and dosing schedule. The ranking distributions were significantly different for six of 12 factors between patients and general practitioners (Wilcoxon ranked-sum test). Patient experience with antidepressants did not influence factor value. Conclusions: The data demonstrate moderate disagreement between patients and general practitioners regarding the relative value of antidepressant selection factors. The effect of this disagreement on treatment adherence and other outcomes requires further investigation, as improving patient-physician concordance regarding antidepressant choices may lead to improved treatment acceptance.