Advertisement

Adherence and nonadherence to treatment for major depression

A look at reasons for nonadherence and why your healthcare provider is your best source of information.

A woman read the full prescribing information for a depression medication. Understanding dosing instructions, how a medication works, and the side effects that a medication may cause are all important to improving adherence.

Updated on November 8, 2024

Major depressive disorder (MDD) is a mental health condition characterized by persistent low moods. A person with MDD may experience persistent sadness, hopelessness, loss of pleasure and enjoyment, anger, other negative emotions, and thoughts of suicide and/or self-harm. Problems with energy levels, sleep, appetite, concentration, and thinking are also common. These symptoms are severe enough to interfere with normal activities.

While the minimum duration of symptoms required for a diagnosis of MDD is two consecutive weeks, many people with MDD experience symptoms for longer periods of time, and often experience recurring episodes of symptoms.

In addition to MDD, there are other types of depression, and symptoms can vary depending on the type—though all types of depression feature persistent low moods, and all types require diagnosis and treatment.

Treatment for MDD

Treatment for major depressive disorder is typically a combination of antidepressant medications and psychotherapy. Antidepressants are medications that modulate moods and behaviors. These medications act on chemicals in the brain called neurotransmitters. There are many different types of antidepressant medications available, and different medications (and combinations of medications) work better for different people.

Psychotherapy is also known as “talk therapy,” and involves structured therapy sessions where a person will talk to a mental health professional. During these sessions, a person may work to improve awareness of a condition, understand how thoughts and behaviors affect moods, and build skills for coping and problem-solving. There are different types of psychotherapy that may be used in the treatment of depression, and a healthcare provider can explain what type they recommend and why.

A combination of medications and psychotherapy is typically more effective than using either approach on its own, but treatment does vary from person to person. Social support, lifestyle changes, and addressing coexisting health conditions can be other important elements of a treatment plan for depression.

Adherence to treatment

Following a treatment plan as prescribed by a healthcare provider will help a person get the best result from treatment. In medicine, following through with a prescribed treatment plan is referred to as adherence.

In the treatment of MDD, adherence means taking every dose of a medication on schedule. It also means attending appointments with a healthcare provider, including appointments for psychotherapy as well as appointments to monitor a person’s response to medications.

While taking a medication every day and attending appointments may seem like a simple enough routine to follow, it can be challenging for a variety of reasons. Many people who are being treated for depression miss doses of medication and/or miss appointments. Many people stop treatment without being instructed to by a healthcare provider.

Examples of potential reasons for medication non-adherence:

  • Concerns about side effects from medication
  • Forgetting to take a medication
  • Complexity of having to take multiple medications
  • Belief that the medication is not working or will not work
  • Lack of clear instructions on how to take the medication
  • Lack of information on how the medication works and how long it takes to work
  • Side effects, or not liking how you feel while taking a medication
  • Concerns about the cost of treatment

What to do if you need to improve adherence

Better adherence to treatment is associated with better treatment outcomes. Nonadherence to medications increases the risk of relapses/recurrences of major depressive episodes, more severe symptoms, emergency department visits, and hospitalizations.

Take some time to think about your experiences with treatment adherence. It can help to write this information down and bring it to an appointment to discuss with your healthcare providers.

Be honest about your experiences and start a conversation about ways to improve adherence. For example, if your work schedule makes it difficult to remember to take a medication on time, you might set an alarm on a phone or watch to remind you. If you are concerned about side effects, tell your healthcare provider, and ask how side effects can be managed.

Your healthcare provider will be your best source of information—but in order to provide you with the information and the care that you need, your healthcare provider needs to know about your experiences, your questions, and your concerns.

Article sources open article sources

MedlinePlus Medical Encyclopedia. Major depression.
Navneet Bains and Sara Abdijadid. Major Depressive Disorder. StatPearls. April 10, 2023.
Harvard Health Publishing. Major depression.
National Institute of Mental Health. Depression.
Zachary M. Sheffler, Preeti Patel, and Sara Abdijadid. Antidepressants. StatPearls. May 26, 2023.
National Institute of Mental Health. Psychotherapies.
Jerry L Halverson. Depression Treatment & Management. Medscape. May 21, 2024.
Navneet Bains and Sara Abdijadid. Major Depressive Disorder. StatPearls. April 10, 2023.
Tasaduq H. Mir. Adherence Versus Compliance. HCA Healthcare Journal of Medicine, 2023. Vol. 4, No. 2.
Bernardo Dell’Osso, Umberto Albert, et al. How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist. Annals of General Psychiatry, 2020. Vol. 19.
Elizabeth J. Unni, Shaloo Gupta, and Nikoletta Sternbach. Reasons for non-adherence with antidepressants using the Medication Adherence Reasons Scale in five European countries and United States. Journal of Affective Disorders, 2024. Vol. 344.
Beatriz Gonzalez de Leon, Tasmania del Pino-Sedeno, et al. Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis. BCM Psychiatry, 2022. Vol. 22.

Featured Content

article

Can physical pain be a symptom of depression?

Questions and answers about the association between depression and physical pain.
article

Why stigma makes it more difficult to treat depression

If you have ever been treated in a negative way because you have depression, you have experienced stigma.
article

Symptoms of persistent depressive disorder (PDD)

Sometimes called “high-functioning depression,” PDD is a less intense but longer-lasting form of depression.
article

Living with Depression? You Need a Primary Care Provider

Why primary care providers play an essential role in taking care of your health while living with depression.
article

How long does it take for depression treatment to work?

A look at how psychotherapy and antidepressants work—and how long these treatments take to work.