How accurate are patients in reporting their antidepressant treatment history?

Background: A patient’s report of their antidepressant treatment history is one of the most important pieces of information used in selecting an antidepressant regimen. It is currently unknown how accurate patients are in describing and characterizing their antidepressant treatment history. Methods: Seventy-three patients receiving treatment for depression at our outpatient psychiatric practice were interviewed by an independent evaluator who was blind to each patient’s treatment history. Information was obtained regarding which antidepressant and augmentation regimens patients had undergone, antidepressant doses, duration of trials, and the nature of response to each trial. The results of these interviews were then compared with patients’ actual treatment history as elicited from an independent chart review. Results: Patients recalled 85 of the 104 (81.7%) monotherapy trials they had undergone in the past 5 years, but only recalled 12 of 46 (26.1%) augmentation trials (P<0.001). Patients were found to be very reliable in distinguishing between those trials that were of adequate dose and duration and those that were not. Patients were also generally reliable in depicting the quality of response to past trials, though patient report of a past negative trial was significantly more reliable than a report of a past positive trial. The presence of current depressive symptomatology did not adversely affect patients’ ability to recall past trials or accurately describe their responses to past regimens. Limitations: All patients were treated by a single psychiatrist, and all trials occurred within the last 5 years. Conclusion: Patients are able to recall the majority of monotherapy trials they have undergone, but have great difficulty remembering when two medications were taken concurrently, i.e. augmentation trials. Patient report appears to be a satisfactory method to obtain information regarding trial adequacy and response in most, but not all instances.