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Somatoform Symptoms and Treatment Nonadherence in Depressed Family Medicine Outpatients
Arch Fam Med. 2000;9:54.
"Every happy family is the same, but unhappy families are all different."1 So begins the novel Anna Karenina. Were he a physician, Leo Tolstoy may have concluded that unhappy patients are each unhappy in their own way. In fact, research during the last decade has rapidly enriched the description of depression by parsing into types and subtypes.
Several years ago I began noticing that primary care patients were intolerant to antidepressant medications at rates a good bit higher than studies2 coming out of the psychiatric centers reported. I noticed roughly 3 different responses3 to the same medical treatment in ostensibly similar patients with major depression. One "type" of patient could not recall any adverse effects and tolerated the medication easily, while the second complained about adverse effects but seemingly got over the complaints by discussing them with a provider, and the third complained of multiple adverse effects and had great difficulty adhering to treatment. During residency, we were exposed to Michael Balint's idea,4 developed over half a century ago in Britain, that the patient's—or for that matter the physician's—personality can adversely or positively affect therapeutic outcomes. It occurred to me that it might be worthwhile to try to measure some aspects of the depressed patient's personality, and to try to correlate these measurements with medication intolerance. If patients with personality aspects placing them at risk for antidepressant intolerance were flagged, it may then be possible to devise interventions and improve adherence to treatment.
Robert Keeley, MD
Longmont, Colo
REFERENCES
1. Tolstoy L. Anna Karenina. Garnett C, trans. Garden City, NY: International Collectors Library; 1965.
2. Greenberg RP, Bornstein RF, Zborowki MJ, Fisher S, Greengerg MD. A meta-analysis of fluoxetine outcome in the treatment of depression. J Nerv Ment Dis. 1994;182:547-551.
PUBMED
3. Physician's Desk Reference. 53rd ed. Montvale, NJ: Medical Economics Books; 1999.
4. Balint M. The Doctor, His Patient, and His Illness. New York, NY: International Universities Press; 1957.
RELATED ARTICLE
Somatoform Symptoms and Treatment Nonadherence in Depressed Family Medicine Outpatients
Robert Keeley, Marcia Smith, and John Miller
Arch Fam Med. 2000;9(1):46-54.
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