Mood disorder treatment for depression can be challenging – and patients may become frustrated when treatments don’t work.  

In fact, when people with depression take a medication that does not help them, they reported feeling frustrated (80%), angry (32%) or scared (30%), according to the GeneSight® Mental Health Monitor. The nationwide survey found that only 8% of people with depression remain hopeful after a depression medication fails them. 

Additionally, more than half of people diagnosed with depression reported that they have tried four or more depression medications in their lifetime, the nationwide poll found. 

When that process leads patients to quit their medication altogether, there may be steps you can take to get them back on the road to better mental health treatment. 

Medication nonadherence: What is it? 

According to the American Medical Association (AMA) website: “Medication nonadherence – when patients don’t take their medications as prescribed – is unfortunately fairly common, with research showing that patients don’t take their medications as prescribed about half the time.”  

When this happens, it’s important for healthcare professionals to find out why, so they can help, according to the website. 

Reasons Why Patients Stop Their Mood Treatment 

A 2021 survey by the National Alliance on Mental Illness (NAMI) asked patients to share the top reasons they stop taking their treatment for their mood disorder,, and the top five reasons were noted as:  

Reason #1: “It was not working for me” 

About a third of the people in the survey (34%) reported stopping their treatment because they felt the medication wasn’t working.  

“I had taken antidepressants in the past, so I was comfortable with taking what my psychiatrist recommended,” said Iris R. in a GeneSight patient testimonial. “Yet the medication prescribed did not adequately help my depression. I tried a second medication with no more success. The third medication my psychiatrist prescribed had side effects and the depression was getting worse.” 

Many factors may affect medication outcomes, but when a medication doesn’t work as expected, the role that the patient’s genes can play is an often-overlooked consideration. Pharmacogenomic tests, like the GeneSight test, can be used to reveal if there’s genetic variation that may contribute to a greater likelihood of certain medications not working. 

This type of testing may be used to help reduce the frustrating trial-and-error that many patients experience. Sixty-six percent of people “who have ever used routine/maintenance psychiatric medication have used more than three different medications throughout their experience,” according to the NAMI survey. 

GeneSight testing can provide information about which medications may require dose adjustments, may be less likely to work, or may have an increased risk of side effects based on your patient’s genetic information, so a more informed choice may be made. 

“Before switching to a new medication, my psychiatrist suggested the GeneSight test, and I readily agreed. The results confirmed that I was likely unable to metabolize some of the medications normally, validating my experience about side effects and efficacy of the medications I had tried,” said Iris. “My psychiatrist selected a medication from the “use as directed” category, which I have taken for over a year now, and my doctor recommended a methyl folate supplement. These medications have helped my depression start to improve and I had more energy and motivation to work with my therapist and take other steps to improve the depression, like exercising and spending time with friends.” 

Reason #2: “I wanted to see if I could ‘make it on my own’ without treatment” 

About a third of people in the NAMI survey (34%) stopped their medication because they wanted to try life without it. 

Patient Ashley R. struggled with depression for years and had tried many medications without success. When the pandemic hit, it triggered new symptoms, and she received a new diagnosis of bipolar disorder. As she saw the effect her manic symptoms had on her family members, she knew she needed professional help. 

Her doctor recommended a GeneSight test to help inform their medication selection, which changed her life. According to Ashley: 

“Before the GeneSight test, I felt like I was just kind of living by the seat of my pants… Getting a personal in-depth look into my own body’s chemistry made a difference in my treatment. Getting off the rollercoaster of trial-and-error has changed my life.” 

Reason #3: “It had side-effects that were not worth it” 

For 27% of people in the NAMI survey, the side effects they felt during treatment were too unpleasant or made them too uncomfortable to want to continue. However, it may be possible to reduce the likelihood of this roadblock to treatment. 

For example, the clinical considerations included in a GeneSight report describe when variation in one or more pharmacokinetic genes may predict slower than normal metabolism of certain medications. This may result in higher levels of medication in the system and a potential increased risk of side effects. Additionally, there are some pharmacodynamic genes included on the GeneSight test where a certain variation in the gene is associated with an increased risk of side effects. This may make it easier to identify particular medications that may be more likely to produce unwanted side effects for your patient. 

Reason #4: “My symptoms improved so I no longer needed it” 

One-quarter of the people in the survey said their symptoms improved, so they no longer felt the need to continue their treatment. However, symptoms of depression and bipolar commonly reoccur.  

“Major depressive disorder (MDD) is potentially a long-term or even lifelong illness for many patients, and maintenance therapy is designed to prevent relapse in patients with recurrent depression who have achieved remission,” according to an article in the Primary Care Companion to the Journal of Clinical Psychiatry. “Patients who have residual symptoms, ongoing psychosocial stressors, or comorbid illnesses are among the suitable candidates for maintenance treatment.” 

Reason #5: “I could no longer afford the cost of treatment” 

Nearly one-quarter (24%) of the people surveyed stopped treatment because they could no longer pay for it.  

A blog post published by the American Psychiatric Association notes that, “depression is one of the most common mental disorders and can cause tremendous challenge and burden for individuals and families. It also carries a large economic cost.”  

According to a 2021 study published by the journal Pharmacoeconomics: 

“The number of US adults with MDD increased by 12.9%, from 15.5 to 17.5 million, between 2010 and 2018, whereas the proportion of adults with MDD aged 18-34 years increased from 34.6 to 47.5%. Over this period, the incremental economic burden of adults with MDD increased by 37.9% from $US236.6 billion to 326.2 billion (year 2020 values). All components of the incremental economic burden increased (i.e., direct costs, suicide-related costs, and workplace costs), with the largest growth observed in workplace costs, at 73.2%. Consequently, the composition of 2018 costs changed meaningfully, with 35% attributable to direct costs (47% in 2010), 4% to suicide-related costs (5% in 2010), and 61% to workplace costs (48% in 2010).” 

Yet, finding treatment that helps a patient may help reduce  prescription costs. According to a study published in Current Medical Research and Opinion, GeneSight patients realized significant overall annual pharmacy costs savings compared to the control group. They saved, on average, $1,035.60 in total annual medication costs compared to patients who had not been tested. Additionally, taking medications with no or moderate gene-drug interactions resulted in lower medication costs, according to another key finding from the study. 

Of course, the reason a patient may stop taking their mood disorder treatment may not fit neatly into one of these categories. It can be complex. However, if medication is repeatedly failing a patient, their genetics may be one reason. Patients who may be good candidates for the GeneSight test may include: 

• New patients with a previous medication failure 
• Patients who are experiencing lower than desired medication response 
• Patients who are currently experiencing unwanted side effects 
• Elderly patients and patients with liver damage 

For more information about the GeneSight test, please click here to take the next step. 

For more information about this and other important topics, please visit: 

• PCPs: are you playing offense or defense with your patients’ mental health? 
• Understanding the geriatric depression scale in seniors 
• Why don’t some common antidepressants work for patients? 

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 Our articles are for informational purposes only and are reviewed by our Medical Information team, which includes PharmDs, MDs, and PhDs. Do not make any changes to your current medications or dosing without consulting your healthcare provider. 

The GeneSight test must be ordered by and used only in consultation with a healthcare provider who can prescribe medications. As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of your medical history, other medications you may be taking, your family history, and other factors. 

If you are a healthcare provider and interested in learning more about the GeneSight test, please call us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful.