News Editor: Renato M.E. Sabbatini, PhD
People with high blood pressure who are depressed or have signs of depression may be less likely to take their antihypertensive medications than people who are not depressed, new study findings show.
"These findings might help explain why depressed patients have higher rates of cardiovascular morbidity and mortality," lead study author Dr. Philip S. Wang of Brigham and Women's Hospital in Boston, Massachusetts, told Reuters Health.
"Second, these findings raise the possibility that better detection and treatment of depression could lead to additional health benefits for patients through better blood pressure control," he added.
Wang and his colleagues investigated the effect of depression on compliance with blood pressure medications in a study of 496 individuals with high blood pressure. The investigators determined the patients' compliance by analyzing the amount of medication dispensed and the day's supply for each prescription.
Overall, more than one third of the patients did not have or had not obtained enough medication to cover 6 months of the year, and another third had only enough medication to cover 79% of the year, the investigators report in the July issue of the Journal of General and Internal Medicine. Less than one-third had enough medication to cover 80% or more of the year.
Patients who reported a high degree of depressed mood, loneliness, worthlessness or other depressive symptoms were less likely to comply with their medications than their peers, study findings indicate. And their noncompliance increased with the increasing severity of their depressive symptoms, the researchers note. This finding remained true even after Wang and colleagues took into account the patients' age, gender, treatment site and other factors.
The reason for the effect of depression on medication compliance is unknown, but Wang speculates it might be because "depression could reduce patients' motivation or make them pessimistic over the effectiveness of treatments.
"Furthermore, depression can have adverse effects on attention, memory and other cognitive abilities that are needed to consistently take medications over time," he added. "Finally, depression could cause patients to take poorer care of their health or even intentionally harm themselves."
In light of the findings, "healthcare providers may want to more closely monitor how well their depressed patients are taking their medications and provide such patients with special encouragement in this regard," Wang advises.
Also, "it is important for patients to discuss potential symptoms of depression as well as any problems adhering to prescribed medications with their healthcare providers," he said.
SOURCE: Journal of General and Internal Medicine 2002;17:1-8.