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"Medication career" or "Moral career"? The two sides of managing antidepressants: A meta-ethnography of patients' experience of antidepressants

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  • Malpass, Alice
  • Shaw, Alison
  • Sharp, Debbie
  • Walter, Fiona
  • Feder, Gene
  • Ridd, Matthew
  • Kessler, David

Abstract

The UK National Institute for Clinical Excellence (NICE) Clinical Guidelines recommend routine prescription of antidepressants for moderate to severe depression. While many patients accept a prescription, one in three do not complete treatment. We carried out a meta-ethnography of published qualitative papers since 1990 whose focus is patients' experience of antidepressant use for depression, in order to understand barriers and facilitators to concordance and inform a larger qualitative study investigating antidepressant use over time. A systematic search of five databases was carried out, supported by hand searches of key journals, writing to first authors and examining reference lists. After piloting three critical appraisal tools, a modified version of the CASP (Critical Appraisal Skills Programme) checklist was used to appraise potentially relevant and qualitative papers. We carried out a synthesis using techniques of meta-ethnography involving translation and re-interpretation. Sixteen papers were included in the meta-ethnography. The papers fall into two related groups: (1) Papers whose focus is the decision-making relationship and the ways patients manage their use of antidepressants, and (2) Papers whose focus is antidepressants' effect on self-concept, ideas of stigma and its management. We found that patients' experience of antidepressants is characterised by the decision-making process and the meaning-making process, conceptualised here as the 'medication career' and 'moral career'. Our synthesis indicates ways in which general practitioners (GPs) can facilitate concordant relationships with patients regarding antidepressant use. First, GPs can enhance the potential for shared decision-making by reviewing patients' changing preferences for involvement in decision-making regularly throughout the patient's 'medication career'. Second, if GPs familiarise themselves with the competing demands that patients may experience at each decision-making juncture, they will be better placed to explore their patients' preferences and concerns - i.e. their 'moral career' of medication use. This may lead to valuable discussion of what taking antidepressants means for patients' sense of self and how their treatment decisions may be influenced by a felt sense of stigma.

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  • Malpass, Alice & Shaw, Alison & Sharp, Debbie & Walter, Fiona & Feder, Gene & Ridd, Matthew & Kessler, David, 2009. ""Medication career" or "Moral career"? The two sides of managing antidepressants: A meta-ethnography of patients' experience of antidepressants," Social Science & Medicine, Elsevier, vol. 68(1), pages 154-168, January.
    • Handle: RePEc:eee:socmed:v:68:y:2009:i:1:p:154-168
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    References listed on IDEAS

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    1. Stevenson, Fiona A. & Barry, Christine A. & Britten, Nicky & Barber, Nick & Bradley, Colin P., 2000. "Doctor-patient communication about drugs: the evidence for shared decision making," Social Science & Medicine, Elsevier, vol. 50(6), pages 829-840, March.
    2. Holt, Martin, 2007. "Agency and dependency within treatment: Drug treatment clients negotiating methadone and antidepressants," Social Science & Medicine, Elsevier, vol. 64(9), pages 1937-1947, May.
    3. Fife, Betsy L., 2005. "The role of constructed meaning in adaptation to the onset of life-threatening illness," Social Science & Medicine, Elsevier, vol. 61(10), pages 2132-2143, November.
    4. Campbell, Rona & Pound, Pandora & Pope, Catherine & Britten, Nicky & Pill, Roisin & Morgan, Myfanwy & Donovan, Jenny, 2003. "Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care," Social Science & Medicine, Elsevier, vol. 56(4), pages 671-684, February.
    5. Fife, Betsy L., 1994. "The conceptualization of meaning in illness," Social Science & Medicine, Elsevier, vol. 38(2), pages 309-316, January.
    6. Donovan, Jenny L. & Blake, David R., 1992. "Patient non-compliance: Deviance or reasoned decision-making?," Social Science & Medicine, Elsevier, vol. 34(5), pages 507-513, March.
    7. Guadagnoli, Edward & Ward, Patricia, 1998. "Patient participation in decision-making," Social Science & Medicine, Elsevier, vol. 47(3), pages 329-339, August.
    8. Pound, Pandora & Britten, Nicky & Morgan, Myfanwy & Yardley, Lucy & Pope, Catherine & Daker-White, Gavin & Campbell, Rona, 2005. "Resisting medicines: a synthesis of qualitative studies of medicine taking," Social Science & Medicine, Elsevier, vol. 61(1), pages 133-155, July.
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