Physician strategies for addressing patient adherence to prescribed psychotropic medications in Japan: a qualitative study

Summary Background and objectives: Effective psychiatric care requires physicians to address the problems of patient adherence to prescribed medications. The aim of this study was to understand physician‐perceived barriers to, and effective strategies for, prescribing anti‐depressants in Japan. Methods: A qualitative study using semi‐structured and key‐informant interviews with a purposive sample of Japanese psychiatrists and key‐informant physicians who had practiced in both the US and Japan. Results: Japanese psychiatrists recognize patient misperceptions, social stigma and resistance to acceptance of prescribed anti‐depressant medication. Physicians also recognize that selective serotonin reuptake inhibitors (SSRIs) decrease rather than reinforce patient resistance. Physicians initially underdose, employ euphemisms and accept patient decisions to decline treatment by medication. Discussion: Even after the introduction of SSRI anti‐depressants in 1999, Japanese psychiatrists’ primary adherence strategy to initially underdose prescribed anti‐depressants remains. The unstated physician strategy is to allow the pharmaceutical industry to address patient misperceptions, social stigma and the resistance to prescription therapies. Conclusions: The results of this study delineate the fundamental strategies employed by Japanese physicians to address patient adherence to prescribed psychotropic medications, primarily to reduce the initial dose rather than to stress patient education.