Abstract
Introduction: Factors relating to the interpersonal relationship between the patient and their physician and social environment are important components, which contribute to their response to treatment for major depressive disorder. This study aimed to assess the influence of optimism, perfectionism, therapeutic alliance, empathy, social support, and adherence to medication regimen in the response to antidepressant treatments in the context of normal primary care clinical practice.Method: We conducted a prospective study in which 24 primary care physicians administered sertraline or escitalopram to 89 patients diagnosed with major depressive disorder. The response to treatment and remission of the episode was assessed at 4 and 12 weeks by Cox regression. The effect of adherence to the medication regimen was assessed by multiple regression statistical techniques.Results: Adherence to medication (HR = 0.262, 95% CI = 0.125–0.553, p < 0.001) and patient perfectionism (HR = 0.259, 95% CI = 0.017–0.624, p < 0.01) negatively predicted the initial response to treatment, whereas patient optimism (HR = 1.221, 95% CI = 1.080–1.380, p < 0.05) positively predicted it. Patient optimism (HR = 1.247, 95% CI = 1.1–1.4, p < 0.05), empathy perceived by the patient (HR = 1.01, 95% CI = 1001–1002, p < 0.05), and therapeutic alliance (HR = 1.02, 95% CI = 1001–1.04, p < 0.05) positively predicted episode remission, while patient perfectionism (HR = 0.219, 95% CI = 0.093–0.515, p < 0.001) and low adherence to the treatment regimen (HR = 0.293, 95% CI = 0.145–0.595, p < 0.001) negatively predicted it. Finally, social support (p < 0.01) and therapeutic alliance (p < 0.05) predicted adherence to the medication regimen.Conclusions: In addition to taking the antidepressant drug, other factors including the personal interactions between the patient with their primary care physician and with their social environment significantly influenced the patients' initial response and the final rate of episode remission.
Highlights
Factors relating to the interpersonal relationship between the patient and their physician and social environment are important components, which contribute to their response to treatment for major depressive disorder
The 24 general primary-care physicians (GPs) who participated in the study identified 147 patients with a possible diagnosis of major depressive disorder who were seen consecutively at the Paterna Health Centre over a period of 1 year
There were no differences between men and women for any of the variables and there were no significant results in the measurements of response or remission with respect to gender, age, civil status or education-level variables of the patients, nor any of the sociodemographic variables of the GPs
Summary
Factors relating to the interpersonal relationship between the patient and their physician and social environment are important components, which contribute to their response to treatment for major depressive disorder. This study aimed to assess the influence of optimism, perfectionism, therapeutic alliance, empathy, social support, and adherence to medication regimen in the response to antidepressant treatments in the context of normal primary care clinical practice. Major depressive disorder is a heterogeneous condition characterized by a diagnosis of syndromic validity, without biological specificity. Non-specific responses to antidepressant pharmacological treatment play an important role in their efficacy. A wide range of drugs with demonstrated efficacy show a high rate of response to placebos [6,7,8,9], which has even led some authors to question the use of drugs to treat mild depression [6]
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