Decision Tool Helps Doctors Talk to Patients about Antidepressants

Assisting depressed patients in choosing the right antidepressant can help patients feel better about their medication choices, according to findings published in JAMA Internal Medicine.

Researchers from the Mayo Clinic developed the Depression Medication Choice (DMC) encounter decision aid, designed to help patients and clinicians consider the available antidepressants and the extent to which they improved depression and other issues important to the patients. The researchers then conducted randomized trial of 117 patients and 301 clinicians using DMC in order to evaluate the tool’s effect on the quality of the decision making process and depression outcomes.

“We worked closely with patients, their families, and clinicians to fully understand what really matters to them when confronted with this situation,” first author Annie LeBlanc, PhD, explained in a press release. “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.”

DMC significantly improved patients’ decisional comfort compared to usual care, 80 percent to 75 percent, respectively. The patients’ satisfaction and involvement was improved with DMC over usual care. For the clinicians, decisional comfort was improved (80 percent compared to 68 percent with usual care) as well as their satisfaction.

The researchers did not find any differences in encounter duration, medication adherence, or improvement of depression control between the usual care or DMC groups.

The statement continued by adding that the main differences between the way patients and clinicians examine antidepressants is their focus. Patients often focus on their expectations, treatment efficacy, or unacceptable side effects, and may abandon medication adherence when some of these factors are compromised. On the other hand, clinicians typically focus on the medication’s stated effectiveness instead of a patient’s broader needs and preferences, the statement added.

The use of the DMC tool did not impact the length of medication discussions between patients and clinicians. Additionally, the researchers did not conclude a difference in effectiveness or adherence to medication with usual care or the use of the DMC tool.

“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,” concluded 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.”