Psychiatria pre prax 2/2023

Shared decision making in treatment of depressive disorder

Depressive disorder represents a significant burden for patients, relatives and society. This is due to its prevalence, course, potential to lead to long-term or permanent disability or high treatment costs due to frequent rehospitalizations. Considering the further prognosis of patients with a depressive disorder with regard to disability and the achievement of an adequate dual remission, shortening the duration of an untreated depressive episode to a minimum appears to be a key condition. Antidepressants, which represent the cornerstone of the therapy of depressive disorder, are considered effective and safe treatment. However, a high rate of non-adherence to therapy remains a problem, even in the early stages of depressive disorder. Main reasons for non-adherence are ineffectiveness and adverse effects of antidepressants. However, since preferences regarding treatment, side effects and goals that the patient wants to achieve through therapy are individual, including the patient in the decision-making process appears to be a suitable strategy for improving adherence. The majority of patients with a depressive disorder want to actively participate in this process, while the possible side effects of the treatment appear to be a key area of decision-making. Experience from somatic medicine as well as research in the field of mental health indicate improved treatment outcomes when a patient-centered approach that includes shared treatment decision-making is adopted. Shared decision-making on treatment with an emphasis on patient preferences and joint selection of an appropriate antidepressant, also with regard to possible adverse effects, can lead to a more significant therapeutic benefit and a full-fledged dual remission through improved adherence. The mentioned case report demonstrates a patient with a first episode of a depressive disorder, in whom a remission of a depressive disorder with good adherence to treatment was achieved in a psychiatric outpatient clinic through the approach of shared decision-making. The case report illustrates and suggests a procedure of shared decision-making about treatment in outpatient psychiatric setting, which is not time-consuming and can improve therapeutic alliance as well as treatment results.

Keywords: depressive disorder, antidepressants, adherence, share decision-making, remission