




































 
 
  

 

24 

Ann. psychophysiol. 
ISSN 2412-3188 (Online) | 2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v8.i1.2021.24-33 
 

 
Original Article                                                                                  

Assessing the beliefs about antidepressant 
medication and adherence to therapy in 
patients with major depressive disorders 
Samia Perwaiz Khan1 , Shagufta Naqvi1, Rabeea Rizwan1, Mariam Ansari1, 
Shaista Emad1,2, Habib ur Rahman Khan1, Aafia Akhtar1,  
Maniya Syed1, Naija Ehsan1 & Anas Moorad1 
1Jinnah Medical and Dental College (JMDC), Karachi-Pakistan.   
2Sohail University, Karachi-Pakistan.   
 

Abstract 
Background: Patients on antidepressant therapy have no contact with their 
physicians until their next appointment, which in most cases could be more than 
two weeks apart. This crucial time is of utmost importance as this could assess the 
patient's will to follow the prescribed therapy and the general belief about the 
benefits of using antidepressant treatment. Thus medication adherence is 
necessary to reduce the risk of suicidal tendencies and mortality in these patients. 
The study aimed to evaluate medication adherence and adherence to 
antidepressant therapy in patients with major depressive disorder. 
Methodology: in this cross-sectional study, a total of 101 clinically diagnosed 
patients with Major Depressive Disorder (MDD) were included in the study from 
psychiatric and medical OPD from June 2018 to June 2019, from Jinnah Medical 
College Hospital (JMCH). Belief about medicines questionnaire (BMQ specific and 
BMQ general), regarding their views about the prescribed medication and the 
modified questionnaire of the medication adherence scale used, scores were 
calculated to give a numerical value to measure the adherence to antidepressant 
medication. 
Results: According to the study, 101 patients with major depressive disorder had 
an overall good belief about medication but have low adherence.   Belief about 
medicines questionnaire (based on BMQ) BMQ- the specific q1-10 score was 36.54 
(necessity, concern), BMQ-general 27.98 score, q11-18 (overuse and harm). 
Regarding their views about the prescribed medication.  86% of participants with 
the major depressive disorder had low adherence (scores 0-5), and those with high 
adherence were only 14% (scores 6-8). The patients diagnosed with the major 
depressive disorder who had co-morbid (diabetes, hypertension, hypothyroidism, 
etc.) had better adherence for their prescribed treatment as compared to those 
without co-morbid. 
Conclusion: This study indicates that although patients with major depressive 
disorder from tertiary care hospitals in Karachi had a positive belief about 
medication but have low adherence to antidepressant therapy. 

Keywords 
Major Depressive Disorder, Antidepressant Drugs, Medication Adherence, Belief, 

Modified Adherence Questionnaire. 

Citation: Khan SP, Naqvi S, Rizwan R, 
Ansari M, Emad S, Khan HR, Akhtar A, 
Syed M, Ehsan N, Moorad A. Assessing 
the beliefs about antidepressant 
medication and adherence to therapy in 
patients with major depressive disorders. 
APP.2021; 8(1):24-33 
 
Corresponding Author Email: 
samiaphk@gmail.com 
 
DOI: 10.29052/2412-3188.v8.i1.2021.24-33 
 
Received 09/12/2020 
 
Accepted 12/05/2021 
 
Published 01/06/2021 
 
Copyright © The Author(s). 2021 This  
 is an open access article distributed 
under the terms of the Creative 
Commons Attribution 4.0 International 
License, which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author 
and source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 
 

https://doi.org/10.29052/2412-3188.v8.i1.2021.
https://orcid.org/0000-0003-3154-1785
http://creativecommons.org/licenses/by/4.0/)
http://creativecommons.org/licenses/by/4.0/)
http://creativecommons.org/licenses/by/4.0/)


 
 
 

25 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

Introduction  
According to WHO, depression is a cause of 
a major burden on public health globally. 
Depression affects over 350 million people 
globally1. Depression is associated with low 
mood, loss of interest in daily activities, 
decreased energy, disturbed sleep and 
altered appetite, reduced performance and 
worst scenario, it can lead to suicides1,2. 
There are two modes of treatment, 
psychotherapy and antidepressant 
pharmacotherapy. Antidepressant therapy 
is most important in reducing the symptoms 
of depression. Belief about medicine 
questionnaire (BMQ)2 is useful as a tool to 
assess the high risk of non-adherence. By 
improving patients, knowledge about their 
illness might positively affect their 
medication adherence. Non-adherence to 
medicines can be defined as patients not 
taking medication prescribed for the illness, 
leading to poor patient outcomes. Non-
adherence leads to an increase in morbidity 
and mortality. Patients with chronic illnesses 
such as depression have difficulty in drug 
adherence due to prolonged therapy periods 
and certain side effects. 
 
Also, once they start feeling better, they tend 
to stop taking the much-required 
medication. Belief about medication is an 
essential factor in adherence, specifically 
when symptoms of depression are 
improving. Negative beliefs include fear of 
adverse-effects, drug dependence and 
expenditure2, 3. A major depressive disorder 
is a mood disorder that causes sadness and 
loss of pleasure over a prolonged period 
once antidepressant therapy has been 
selected. The initial prescription is of sub-
therapeutic dose. It can be gradually 
increased on the follow-up, keeping a close 
watch for any symptoms of adverse -effects4. 
It has been reported that major depression is 
common in primary care hospitals5. This 
study was conducted to assess 

antidepressant drug adherence in MDD 
patients and their belief and outcomes in a 
tertiary care setting of Karachi city of 
Pakistan.  
 

Methodology 
The study was performed on patients 
attending Jinnah Medical College Hospital 
(JMCH) Korangi, Karachi, to treat the major 
depressive disorder. A total of 101 patients 
were interviewed based on a belief about 
medicines questionnaire (BMQ) regarding 
their views about the prescribed medication. 
BMQ is a tool to measure medication's 
cognitive representation and is valid and 
reliable in various diseases medications. 
BMQ has a five-item scale.  It has two parts: 
assessing patients' beliefs about their 
medications (BMQ-specific) and assessing 
patients' beliefs about medications in general 
(BMQ-general).  
 
The BMQ-specific part covers two themes; 
the specific necessity theme evaluates 
patients' views about the necessity and 
importance of their medication. The specific 
concern theme comprises patients' beliefs 
about potential harm and adverse effects of 
their medications and each of which has a 
score ranging from 5 to 25. A high score in 
the necessity theme means that patients 
think their medications are vital to them; on 
the other hand, a high score in the concerns 
theme means that patients are concerned and 
worried about their medications.  
 
Likewise, the BMQ-general part has two 
themes; the general overuse theme assesses 
how patients perceive the extent of 
medication usage. The general harm theme 
represents patients’ beliefs about the 
harmful nature of medication in general. The 
scores of the last two themes range from 4 to 
20, and the high score in each theme means a 
negative perception of medications in 
general. BMQ-Specific: Specific-necessity 



 
 
 

26 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

(Q1-Q10): higher scores represent stronger 
beliefs for the need for medication to 
maintain health. BMQ-General: overuse 
(Q11-Q14): higher scores indicate negative 
views about the way medicines are 
prescribed. We changed some of the 
questions to make them more applicable to 
our study population. 
 
With the help of a modified form of a 
questionnaire (based on the Medication 
adherence scale), a score was calculated to 
give a numerical value to measure the 
adherence to antidepressant medication. 
Low adherence was 0-5, and high adherence 
scores were 6-14. Questionnaires were filled 
in by interviewing the patients with major 
depressive disorder concerns about 
medicines and their perceptions of the 
medicines' necessity. 
 
The research was carried out one year from 
June 2018 to June 2019. Patients included in 
the research were diagnosed with Major 
Depressive Disorder and those who gave 
consent to participate in the research. 
Individuals with any other psychiatric 
disorder (bipolar, psychosis or substance 
abuse) or concomitant medications other 
than antidepressants were excluded from the 
study.  

Written informed consent were obtained and 
the study protocol was approved by the 
ethical committee of Jinnah medical and 
dental college, Karachi, Pakistan. 
 
Statistical analysis was carried out using 
SPSS version 20.0. New variables were 
designed by recoding and computing 
commands. Descriptive statistics of 
continuous variables, mean, standard 
deviation, and categorical variables, 
frequency and percentages were calculated. 
 

Result 
Out of the total, 80 patients were included 

from the psychiatry out-patient department, 

and 21 patients were included from the 

medicine out-patient department. The 

sample comprised of 41 males and 60 

females. Around 56% of the participants 

were employed at the time of data collection 

and 39% earned within the range of 11-

30,000 per month. 43% were smokers, 

consuming average 9 ± 4.09 cigarettes per 

day. Fifty-three participants were 

overweight. Other baseline characteristics of 

the study participants are given in table 1.  

 

Table 1: Baseline characteristics of the study participants. 

Variable  n=101 

Age (years) 42.85±12.729 

Number of children 4±2 

Cigarettes per day 9±4.098 

Time diagnosed with depression (years) 2.26±2.033 

Time diagnosed with co-morbid (years) 6.45±5.430 

OPD 
Psychiatry OPD 80(79.20) 

Medicine OPD 21(20.79) 

Gender 
Male 41(40.59) 

Female 60 (59.40) 

Employment status 
Not employed 45(44.55) 

Employed 56(55.44) 

Monthly Income <10,000 31(30.69) 



 
 
 

27 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

11-30,000 39(38.61) 

31-50,000 26(25.74) 

>51,000  5(4.95) 

Smoking Status 
No 58(57.42) 

Yes 43(42.57) 

BMI (kg/m2) 

Normal (up to 24.99) 38(37.62) 

Overweight (25-29.99) 53(52.47) 

Obese (>30) 10(9.90) 

No  co-morbid 70(69.30) 

Co-morbid condition  Diabetes Mellitus Type 1 2(1.98) 

Diabetes Mellitus Type 2 7(6.93) 

Hepatitis A 1(0.99) 

Hypertension 14(13.86) 

Hypothyroidism 1(0.99) 

Peptic Ulcer Disease 2(1.98) 

Rheumatoid Arthritis 1(0.99) 

Systemic Lupus Erythematous 3(2.97) 

Medication used 

Bupropion 3(2.97) 

Citalopram 5(4.95) 

Escitalopram 40(39.60) 

Fluoxetine 21(20.79) 

Paroxetine 11(10.89) 

Pregabalin 1(0.99) 

Sertraline 20(19.80) 

Timing of Medication 

Evening 46(45.54) 

Morning 32(31.68) 

Morning evening 23(22.77) 

Scheme of Medicine 
Once a day 68(67.32) 

Twice a day 33(32.67) 
OPD-Outpatient Department; BMI-Body Mass Index 

*Values are given as mean±SD or n(%) 

  

Only sixteen 16% (16 out of 101) of participants in our study had a family member diagnosed 

with depression, with the most prevalent relation being their mother 6% (total of 6 out of 16). Of 

these family members diagnosed with depression, only 38% (6 out of 16) were being medically 

treated (Table 2). 

 

 

 

 

 

 

 

 



 
 
 

28 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

Table 2: Family history of the study participants.  

Variable   n(%) 

A family member diagnosed  
with depression 

No 85(84.15) 

Yes 16(15.84) 

Relation to Patient 

Brother 4(25.0) 

Cousin 1(6.0) 

Grandmother 1(6.0) 

Mother 6(37.89) 

Sister 2(11.9) 

Son 2(11.9) 

Being treated Medically 
No  10(63.0) 

Yes 6(38.0) 

 

 

Table 3:  Mean scores of Believe about Medication Questionnaire (BMQ) 

Variable  Mean±SD Median(IQR) 

BMQ general (q11-q18) 27.98±5.703 29.00(8) 

BMQ specific (q1-q10) 36.54±5.895 38(9) 

BMQ specific-necessity (q1-q5) 17.48±3.882 18(6) 

BMQ specific-concerns (q6-q10) 19.07±2.758 19(4) 

BMQ general overuse (q11-q14) 14.04±3.193 14(5) 

BMQ general-harm (q15-q18) 13.94±3.267 14(5) 

 

 

Using the questionnaire on adherence, a score was calculated to give a numerical value to 

measure the adherence to antidepressant medication. The study has shown 87% of participants 

had a low adherence score (0-5), while only 14% had a high adherence score (6-8) (Table 4). 

 

Table 4: Adherence in patients with major depressive disorder (MDD). 

 

Variable  n(%) 

Adherence 
Low   0-5 86(85.14) 

High   6-8  15(14.8) 

 



 
 
 

29 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

 
Figure 1: Correlation between Patients’ adherence levels on a prescribed  

Antidepressant drug regimen. 
Significant correlation was observed between adherence level and Escitalopram as shown in 
figure 1 (r=0.9). 
 

 

Discussion 
This study was conducted in Karachi's 
population to evaluate adherence to 
antidepressant medication and belief about 
medication, where 101 OPD patients 
diagnosed with MDD were enrolled from. 
Around 80% of them belonged to psychiatry 
OPD, and 21% from medicine OPD.  A 
similar study conducted in a tertiary care 
setting of Karachi in 2012, notified 432 major 
depressive disorder patients, of which 53% 
belong to medicine and 47% from Surgery 
units at the age of 405. European studies6,7 

showed that adults and people in middle age 
are frequently ignored and overlooked 
within mental health policy and research. 
According to global data of 2015, World 
Health Organization (WHO) stated 322 
million people with depression8. They 
notified it 5.1% more common among 

females as compared to males (3.6%), where 
regionally depression noted 50% only in 
South East Asia and Western Pacific areas 
with gender prevalence highest and lowest; 
5.9% amongst females in Africa and 2.5% 
amongst males in Western Pacific areas8. 
While in this study, females 60% were more 
depressed in comparison to males. The most 
common relative with diagnosed depression 
were mother 6%. Other studies supporting 
these findings also narrated that 68% of 
females and 57% of males and relatives with 
mental health problems were parents9.  
 
In our study in Karachi, the highest 
frequency of these depressive patients was 
professionally employed at 56% at the 
highest prevalent income range of 11,000 to 
30,000. Although in the study done in 
Peshawar at Khyber Medical College, a 
major depressive disorder was 64% in adult 



 
 
 

30 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

people earning more than 15,000/month10. 
Thus these outcomes are in agreement that 
socio-economic status plays an essential role 
in an individual's life. Many publications are 
demonstrating its negative association with 
depression11-13.  
 
Our study shows the frequency of smokers 
as 43% at mean 9 ± 4 cigarettes/ day. A 
survey conducted in 2011 showed the 
highest depression in adults who smoke 
more than five cigarettes/day14. Another 
study supported these outcomes, positive 
association of tobacco cigarettes with 
depression was observed among 89% of the 
enrolled subjects15. It is assumed that people 
with depression smoke more to relieve their 
depression; thus, their consumption of 
cigarettes increases every day15. 
 
Another demographic variable that is BMI 
resulting in our findings was 53% highest in 
depressive patients who were overweight 
and obese 10%   while in contrast to two 
studies with the highest 34% and 35% 
incidence of obese16,17. According to WHO 
and other studies on depression has 
indicated depression is the second leading 
cause of disability in Years Lived with 
Disability (YLDs) 18,19. Netherlands Mental 
Health Survey and Incidence Study 
(NEMESIS-2) represented the meantime 
since being diagnosed with depression for 
participants in our study was 2.26 years with 
the meantime since being diagnosed with a 
co-morbid being 6.45 years18. Additionally, 
depression itself is also a risk factor for 
attaining some types of general medical 
ailments, particularly cardiovascular 
disease20, which was also reported in our 
study. The total number of MDD patients 
reported with co-morbid was 31%. Tripathi 
et al. reported Diabetes Mellitus as the most 
common co-morbid 5.78% in depressive 
patients21.  
 

In this study, the common comorbidity 
observed in MDD patients was 14% 
Hypertension and 9% Diabetes Mellitus but 
70% of patients with no associated 
comorbidity. Other studies stated 
cardiovascular disease as the most prevalent 
57% co-morbid medical condition with 
depression22,23. 
 
It is known that a variety of antidepressant 
drugs available with different classifications 
and mechanisms of action. However, 
improbability persists in which therapeutic 
medication or its class provides the best 
therapeutic option. According to current 
clinical medical treatment guidelines by 
NICE (National Institute for Health and Care 
Excellence), 2019 SSRIs (e.g. fluoxetine, 
sertraline, escitalopram, paroxetine) are 
recommended as the first drug of choice for 
depression)24,25. Cipriani et al. recognized the 
best three drugs of choice for treating 
depression: agomelatine, escitalopram, or 
vortioxetine25. We assessed that escitalopram 
(40%) and sertraline (20%) were the most 
commonly prescribed antidepressant drugs 
while the least prescribed was Pregabalin i.e. 
1%.  
 
A study was done in five tertiary care of 
India also displayed their data that 
escitalopram was the most commonly 
prescribed antidepressant drug to 
depressive patients. At the same time, 
trazodone was the least prescribed at 0.96% 
in the year 201621. As we know that the major 
problem we come across in treating 
depressive disorders is the patients' 
adherence and acceptability to drug therapy. 
In the past, it resulted in augmented relapsed 
risk26. Therefore we evaluated patients' 
acceptability and tolerance in our study, 
which was found 86% low adherence, 
especially in those patients whose age was 
above 45 years (95%).  In their study, 
Tamburrino et al. showed 10% of patients 



 
 
 

31 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

were non-adherent to antidepressant drug 
therapy, among which all were at age less 
than 40 years27. A retrospective study also 
shows its results on analogue to our study of 
low adherence 77% in the primary 
psychiatric care of Thailand28.  
 
A study done as UK Defeat Depression 
Campaign indicated that the effective 
antidepressant drug therapy, the treatment 
duration should not be less than four 
consecutive months, but in their study, they 
found only 31% of patients adherence to the 
fourth month (SSRIs: fluoxetine: 31%; 
paroxetine: 30%; sertraline: 24%)25, 29.  This 
study showed that the higher rate of 
adherence (17%) is in males with the P-value 
of 0.324, and it was also observed that 
patients who were never married had a 
higher percentage of adherence (18%). A 
study done by Hans Wouters of Netherlands 
showed females with higher adherence 
(78%), and the most adherent patients (73%) 
lived as partners with a spouse30.  One of the 
reasons for the patient's low drug adherence 
is the social, financial, family barriers and 
beliefs; mostly, it was noted that the spouses 
related non-compliance as they discourage 
their partners from continuing their 
medication. The other reasons stated are 
discouragement from family members and 
fear of drug dependency due to lack of 
communication with the clinician31.   
 
BMQ was an important tool to identify 
psychological factors important in non-
adherence to medication in chronic 
diseases32. This study also has proved the 
utility of this questionnaire for non-
adherence to antidepressant therapy, which 
may increase the risk of relapse.  
 

Conclusion 
This study concluded that the belief about 

medication in MDD patients on 

antidepressant therapy was sufficient in 

participants included from Karachi. 

However, they were evaluated to have low 

adherence to antidepressant treatment. By 

assessing and counselling MDD patients and 

regular follow-up appointments can 

minimize patients' low drug adherence. 

Successful treatment outcomes in MDD most 

necessary as they can be at high risk of 

morbidity, mortality and suicides to 

unmanaged symptoms of depression.  

Counselling and regular doctor-patient 

interaction can improve their compliance 

with medications. 

 

Acknowledgment  
The authors would like to acknowledge the 
patients of Jinnah Medical hospital for 
participating in this study.  
 

References  
1. Marcus M, Yasamy MT, van Ommeren MV, 

Chisholm D, Saxena S. Depression: A global 
public health concern. 2012. Available at: 
https://www.who.int/mental_health/mana
gement/depression/who_paper_depression_
wfmh_2012.pdf 

2. Gagnon MD, Waltemurer E, Martin A, 
Fridenson C, Gayle E and Hausen DL. Patient 
beliefs have a greater impact than barriers on 
medication adherence in a community health 
centre. J. Am. Board Fam. Med. 2017;30(3):331-
336.  

3. Lim GY, Tam WW, Lu Y, Ho CS, Zhang MW, 
Ho RC. Prevalence of Depression in the 
Community from 30 Countries between 1994 
and 2014. Scientific Rep. 2018;8(1):2861. 

4. Sweileh WM, Sa’ed HZ, Nab’a RJ, Deleq MI, 
Enaia MI, Sana’a MN, Al-Jabi SW. Influence of 
patients’ disease knowledge and beliefs about 
medicines on medication adherence: findings 
from a cross-sectional survey among patients 
with type 2 diabetes mellitus in Palestine. 
BMC public health. 2014;14(1):1-8.  

5. Ng CWM, How CH, Ng YP. Managing 
depression in primary care. Singapore Med J. 
2017;58(8):459. 



 
 
 

32 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

6. Edwards J. Fundamental facts about mental 
health. London: Mental Health Foundation; 
2016. Available at: 
https://www.mentalhealth.org.uk/sites/def
ault/files/fundamental-facts-about-mental-
health-2016.pdf 

7. Depression W. Other Common Mental 
Disorders: Global Health Estimates. Geneva: 
World Health Organization. 2017:1-24. 

8. Gatsou L, Yates S, Hussain S, Barrett M, 
Gangavati S, Ghafoor R. Parental mental 
illness: incidence, assessment and practice. 
Men Health Prac. 2016;19(5). 

9. Ishtiaq M, Afridi MI, Imranullah, Khan SA. 
Depression among the adult population; 
prevalence & risk factors of depression among 
adult population of district Peshawar. 
Professional Med J 2018; 25(8):1229-1234. 

10. Andrade L, Caraveo-Anduaga JJ, Berglund P, 
Bijl R, Kessler RC, Demler O, Walters E, Kylyc 
C, Offord D, Ustun TB, Wittchen HU. Cross-
national comparisons of the prevalences and 

correlates of mental disorders. Bull. World 
Health Organ. 2000;78:413-425. 

11. Jo SJ, Yim HW, Bang MH, Lee MO, Jun TY, 
Choi JS, Lee MS, Lee WC, Park YM. The 
association between economic status and 
depressive symptoms: an individual and 
community level approach. Psychiatry 
Investig. 2011;8(3):194-200. 

12. Freeman A, Tyrovolas S, Koyanagi A, 
Chatterji S, Leonardi M, Ayuso-Mateos JL, 
Tobiasz-Adamczyk B, Koskinen S, Rummel-
Kluge C, Haro JM. The role of socio-
economic status in depression: results from 
the COURAGE (aging survey in Europe). 
BMC public health. 2016;16(1):1-8. 

13. Byeon H. Association among smoking, 
depression, and anxiety: findings from a 
representative sample of Korean 
adolescents. Peer J. 2015;3:e1288. 

14. Fluharty M, Taylor AE, Grabski M, Munafò 
MR. The association of cigarette smoking 
with depression and anxiety: a systematic 
review. Nicotine Tob. Res.  2017;19(1):3-13.  

15. Moussa OM, Ardissino M, Kulatilake P, 
Faraj A, Muttoni E, Darzi A, Ziprin P, 
Scholtz S, Purkayastha S. Effect of body 
mass index on depression in a UK cohort of 
363 037 obese patients: A longitudinal 

analysis of transition. Clinical obesity. 
2019;9(3):e12305. 

16. Qato DM, Ozenberger K, Olfson M. 
Prevalence of prescription medications with 
depression as a potential adverse effect 
among adults in the United States. JAMA. 
2018;319(22):2289-2298. 

17. Ferrari AJ, Charlson FJ, Norman RE, Patten 
SB, Freedman G, Murray CJ, Vos T, 
Whiteford HA. Burden of depressive 
disorders by country, sex, age, and year: 
findings from the global burden of disease 
study 2010. PLoS med. 
2013;10(11):e1001547. 

18. Reddy M. Depression: the disorder and the 
burden. Indian J. Psychol. Med. 2010;32(1):1. 

19. Hirschfeld RM. The comorbidity of major 
depression and anxiety disorders: 
recognition and management in primary 
care. Prim Care Companion J Clin 
Psychiatry. 2001;3(6):244. 

20. Tripathi A, Avasthi A, Desousa A, 

Bhagabati D, Shah N, Kallivayalil RA, 
Grover S, Trivedi JK, Shinfuku N. 
Prescription pattern of antidepressants in 
five tertiary care psychiatric centres of India. 
Indian J Med Res. 2016;143(4):507. 

21. Kronick RG, Bella M, Gilmer TP. The faces 
of Medicaid III: Refining the portrait of 
people with multiple chronic conditions. 
Center for Health Care Strategies, Inc. 
2009:1-30. 

22. Goodell S, Druss BG, Walker ER, Mat MJ. 
Mental disorders and medical comorbidity. 
Robert Wood Johnson Foundation. 2011;2. 

23. Sheperd N, Parker C. Depression in adults: 
recognition and management. Clinical 
Pharmacist. 2017. 

24. Cipriani A, Furukawa TA, Salanti G, 
Chaimani A, Atkinson LZ, Ogawa Y, Leucht 
S, Ruhe HG, Turner EH, Higgins JP, Egger 
M. Comparative efficacy and acceptability 
of 21 antidepressant drugs for the acute 
treatment of adults with major depressive 
disorder: a systematic review and network 
meta-analysis. Focus. Lancet. 
2018;16(4):420-429. 

25. Ho SC, Jacob SA, Tangiisuran B. Barriers 
and facilitators of adherence to 
antidepressants among out-patients with 



 
 
 

33 

ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 8 Issue 1  

 

major depressive disorder: A qualitative 
study. PloS one. 2017;12(6):e0179290. 

26. Tamburrino MB, Nagel RW, Chahal MK, 
Lynch DJ. Antidepressant medication 
adherence: a study of primary care patients. 
Prim Care Companion J Clin Psychiatry. 
2009;11(5):205. 

27. Prukkanone B, Vos T, Burgess P, 
Chaiyakunapruk N, Bertram M. Adherence 
to antidepressant therapy for major 
depressive patients in a psychiatric hospital 
in Thailand. BMC psychiatry. 2010;10(1):64. 

28. Donoghue J. Selective Serotonin Reuptake 
Inhibitor Use in Primary Care. Clin Drug 
Investig. 1998;16(6):453-462. 

29. Wouters H, Rhebergen D, Vervloet M, 
Egberts A, Taxis K, van Dijk L, 
Gardarsdottir H. Distinct profiles on 

subjective and objective adherence 
measures in patients prescribed 
antidepressants. Drugs. 2019;79(6):647-654. 

30. Ho SC, Jacob SA, Tangiisuran B. Barriers 
and facilitators of adherence to 
antidepressants among out-patients with 
major depressive disorder: A qualitative 
study. PloS one. 2017;12(6):e0179290. 

31. Wei L, Champman S, Li X, Li X, Li S, Chen 
R, Bo N, Chater A, Horne R. Beliefs about 
medicines and non-adherence in patients 
with stroke, diabetes mellitus and 
rheumatoid arthritis: a cross-sectional study 
in China. BMJ open. 2017;7(10):e017293. 

 

 
 
 
 

 

https://crossmark.crossref.org/dialog/?doi=10.29052/2412-3188.v8.i1.2021.24-33

