Patient-Reported Barriers To Antidepressant Adherence Among Young Adults With Major Depressive Disorder: A Narrative Review

Abstract

Major depressive disorder (MDD) is one of the most common causes of disability in young adults globally, and antidepressant drug therapy is a first-line treatment for moderate-to-severe cases. Although antidepressants are effective, rates of non-adherence are significantly lower in older adults compared with non-adherence in younger adults (ages 18-25 to 18-35 years), with early discontinuation of treatment reported in up to 50% of younger adults after the first 6 months of treatment. This narrative review aims to summarize the patient-reported impediments to antidepressant adherence specific to young adults, based on qualitative, cross-sectional, and systematic review studies published in PubMed, Scopus-indexed journals and PLOS/BMC/Frontiers platforms. Six domains of barriers are identified: (1) intolerable and stigmatizing side effects, particularly sexual dysfunction, weight gain, and emotional blunting; (2) negative beliefs about the necessity to take psychiatric medication, dependency, and the “chemical imbalance” explanatory model; (3) internalized and social stigma associated with taking psychiatric medication during a developmentally identity-forming period; (4) inadequate patient-provider communication and limited shared decision-making; (5) structural and logistical barriers, including cost, insurance discontinuity, and appointment access, which disproportionately affect young adults transitioning out of their parents' coverage and pediatric care; and (6) developmental factors unique to young adulthood, such as symptom-driven self-discontinuation once feeling better, competing life transitions, and low engagement with routine follow-up. Considerations for clinical practice and methodological limitations, such as the underlying evidence base, including the heterogenicity of adherence measurement and the lack of studies limited to a narrow age range of 18-25 years, are discussed. Findings agree with multi-level adherence interventions, which are tailored to each child's developmental level, rather than single factor.