Professionals' perception of the risks of medication use by patients with depressive disorders

Abstract

The study analyzed the perceptions of Primary Health Care and Mental Health professionals regarding risks associated with medication use in the care of people with depressive disorders. This qualitative, exploratory study was conducted in a municipality in the metropolitan region of Porto Alegre, state of Rio Grande do Sul, Brazil, involving professionals from a Primary Care Unit, Family Health Strategy teams, and a Mental Health Support Team. Data were generated through focus groups and analyzed using thematic analysis. Three analytical categories emerged: medication abuse, polypharmacy and therapeutic duplication, and discontinuation of antidepressant use. The findings highlight the centrality of medicalization, weaknesses in pharmacotherapeutic follow-up, and risks to patient safety. It is concluded that strengthening the rational use of psychotropic drugs requires longitudinal monitoring, non-pharmacological strategies, and attention to users’ social conditions.

Keywords
Patient safety; Primary health care services; Medication errors; Chronic diseases; Depressive conditions

Resumo

O estudo analisou a percepção de profissionais da Atenção Primária à Saúde e da saúde mental sobre os riscos do uso de medicamentos no cuidado de pessoas com depressão. Trata-se de pesquisa qualitativa e exploratória, realizada em município da região metropolitana de Porto Alegre, RS, Brasil, com profissionais de uma Unidade Básica de Saúde, equipes da Estratégia Saúde da Família e da Equipe de Apoio em Saúde Mental. Os dados foram produzidos por meio de grupos focais e submetidos à análise temática. Emergiram três categorias analíticas: uso de medicamentos antidepressivos; polifarmácia e terapia duplicada; e abandono do uso de medicamentos antidepressivos. Os achados evidenciam a centralidade da medicalização, fragilidades no acompanhamento farmacoterapêutico e riscos à segurança do paciente. Conclui-se que o fortalecimento do uso racional de psicofármacos exige acompanhamento longitudinal, estratégias não farmacológicas e atenção às condições sociais dos usuários.

Palavras-chave
Segurança do paciente; Atenção Primária à Saúde; Erros de medicação; Doenças crônicas; Quadros depressivos

Resumen

El estudio analizó la percepción de profesionales de la Atención Primaria de la Salud y de la Salud Mental sobre los riesgos del uso de medicamentos en el cuidado de personas con depresión. Se trata de una investigación cualitativa y exploratoria, realizada en un municipio de la región metropolitana de Porto Alegre (Estado de Rio Grande do Sul – Brasil), con profesionales de una Unidad Básica de Salud, equipos de la Estrategia Salud de la Familia y del Equipo de Apoyo en Salud Mental. Los datos se produjeron por medio de grupos focales y se sometieron a análisis temático. Surgieron tres categorías analíticas: uso de medicamentos antidepresivos, polifarmacia y terapia duplicada y abandono del uso de medicamentos antidepresivos. Los hallazgos ponen en evidencia la centralidad de la medicalización, fragilidades en el acompañamiento farmacoterapéutico y riesgos para la seguridad del paciente. Se concluye que el fortalecimiento del uso racional de psicofármacos exige acompañamiento longitudinal, estrategias no farmacológicas y atención a las condiciones sociales de los usuarios.

Palabras clave
Seguridad del paciente; Atención primaria de la salud; Errores de medicación; Enfermedades crónicas; Cuadros depresivos

Introduction

Depression is a chronic and recurrent disorder characterized by episodes in which the individual presents, for a minimum period of two weeks, depressed mood or loss of interest in most activities, frequently accompanied by feelings of guilt, worthlessness, suicidal ideation, and other psychopathological manifestations^1,2. A highly prevalent condition in Brazil and worldwide, depression is one of the main causes of global disability³ and a serious public health problem, with broad clinical, psychosocial, and economic repercussions⁴.

Primary Health Care (PHC) is the main front door of the Psychosocial Care Network (RAPS)^(d), which is part of the Health Care Network (RAS)⁵. In the care of people with depression, follow-up predominantly begins in PHC, and more severe cases are referred to specialized services such as Psychosocial Care Centers (CAPS) and specialty outpatient clinics⁶.

In this context, it is essential to understand the factors that interfere with the drug therapy for depression and to prevent the inappropriate use of psychotropic drugs, avoiding medication errors at the prescribing, dispensing, and administration stages by improving services and enhancing the quality of treatment⁷. In this scenario, PHC plays a strategic role both in the early identification of depressive conditions and in the provision of longitudinal follow-up.

The most frequent errors are those related to polypharmacy, therapeutic duplication, and incorrect administration, which often result from users’ lack of knowledge regarding the appropriate use of medications⁸.

This scenario is aggravated by the progressive increase in prescriptions, associated with poor communication between professionals and users. The latter is expressed by insufficient explanations, difficulties in understanding the purpose of the treatment, and the absence of the Singular Therapeutic Project (PTS), a central device for organizing mental health care and promoting the user’s active participation⁹. Proper communication, therefore, plays a central role in both preventing errors and promoting patient safety in PHC¹⁰. Furthermore, the practice of self-medication favors the irrational use of drugs influenced by family members, social media, the circulation of fragmented information, and low levels of schooling¹¹.

Evidence suggests that non-pharmacological interventions contribute to reducing the risk of depression^12,13 and that psychotherapy is an effective therapeutic alternative, especially in mild cases and when applied in an individualized manner¹⁴. In light of these discussions, the implementation of PTS is a fundamental strategy for building more humanized, effective, and comprehensive practices, even though important challenges persist in the daily routine of services, such as low adherence and fragmentation of care⁹. Integrative and Complementary Health Practices (PICS) are relevant therapeutic resources that reduce the risk of depression, attenuate the adverse effects of antidepressants, and improve users’ quality of life^15-17.

Unsafe health care generates significant economic and social impacts related to the increased use of services, loss of productivity, and illness¹⁸. Thus, strengthening patient safety culture in PHC and expanding scientific production on the subject are essential strategies¹⁹ that should be understood in light of critical approaches to collective health, which problematize care models characterized by excessive medicalization and organizational pressures, frequently associated with iatrogenesis, dependence, and ineffective care²⁰.

Therefore, a non-punitive culture must be strengthened in PHC, oriented towards error prevention and patient safety²¹. In view of the set of elements discussed above, the present study aims to analyze the perception of PHC professionals regarding risks associated with the use of medications by people with depressive disorders.

Methodological aspects

This is a qualitative study with an exploratory design and a critical hermeneutic approach²². The study was developed in the municipality of Sapucaia do Sul, in the metropolitan region of Porto Alegre, state of Rio Grande do Sul, Brazil, in the second half of 2024. The choice of the setting was justified by the presence of a well-structured PHC network and a mental health matrix support team that provides shared care with PHC teams.

The participants were professionals from a Primary Care Unit (UBS) and three Family Health Strategy (ESF) teams from the Municipal Health Department (SMS), in addition to the Mental Health Support Team (EASM) responsible for PHC support. The Primary Care services were indicated by the coordination of the Mental Health Support Team. The selection criteria were teams that frequently provide care for depressed patients and professionals belonging to these teams who had at least six months of experience in PHC.

Data collection was carried out through Focus Groups (FG), with one meeting per team held in primary care units during weekly team meetings, which involved up to fifteen professionals from different categories. The discussions were audio-recorded after the participants signed the Informed Consent Form (ICF).

Each meeting lasted 30 to 50 minutes. The guiding questions addressed longitudinal care, risks related to the use of medications in the treatment of depression, the rational use of psychotropic drugs, polypharmacy, and medication errors. Events that caused harm or risk of harm resulting from the incorrect use of medications in depressed patients were also discussed.

The analysis of the collected material, after transcription, followed the thematic analysis approach developed by Braun and Clarke²³, which comprises six stages: 1) familiarization with the data; 2) generation of initial codes; 3) search for themes; 4) review of themes; 5) definition and naming of themes; 6) production of the report. The interpretation of the results was guided by critical hermeneutics²⁴.

After the transcripts were repeatedly and thoroughly read, the results emerged in line with the research objective. Statements were identified by the following abbreviations: Do (Doctors), N (Nurses), De (Dentists), NT (Nursing Technicians), SW (Social Worker), CHA (Community Health Agents), P (Psychologist), FG1–FG4 (groups formed by PHC teams), and FG5 (group formed by the EASM team).

Pharmacists were not included due to the methodological scope of the study, which focused on the core PHC team. Although psychologists were not formal members of the team, they participated as mental health support. This limitation can be overcome in future studies, expanding the analysis of drug therapy.

The research was approved by the Research Ethics Committee of the Vale do Rio do Sinos University (UNISINOS), under opinion number 3.573.810, in accordance with Resolution No. 466/2012.

Results and discussion

The analysis of the FG data enabled the construction of three analytical categories: medication abuse, polypharmacy and therapeutic duplication, and discontinuation of antidepressant use. The categories are interconnected and express different dimensions of the same care process, marked by the centrality of medication as a response to psychological suffering and by the weaknesses of longitudinal follow-up.

Medication abuse

The onset of drug therapy for depression usually derives from the presence of symptoms such as anxiety and sadness. Over time, some users develop dependence on these drugs, favoring abuse practices²⁵. Prescribing antidepressants without a thorough clinical assessment and adequate therapeutic planning increases this risk, compromising patient safety²⁶. The reports reveal a scenario of medicalization of psychological suffering:

The most common error is generated by patients themselves due to ‘excessive use of medications’; some patients come to renew prescriptions that are supposed to last two months, but they return in 40 days (Do, FG2)

If the patient starts taking these medications and there is no end, no planning, that is the biggest risk [...] (P1, FG5)

It was found that in PHC, there is a progressive increase in the prescription of psychotropic drugs, associated with medication abuse²⁷. If used inappropriately or excessively, these medications pose risks to the health of users. A Brazilian study indicated that antidepressants and antipsychotics are among the medications most frequently involved in intoxication cases²⁸.

Inappropriate prescribing and abuse of psychotropic drugs in PHC derive from multiple factors, such as insufficient professional training, pressure for quick answers, limited consultation time, and the influence of the pharmaceutical market. Such factors favor the prolonged and improper use of these drugs, with risks of excessive sedation, tolerance, withdrawal, and dependence^29,30.

Participants also highlighted users’ preference for drug therapy, associated with the expectation of a quick resolution for their suffering:

People arrive here and ask for medication. It’s very difficult to maintain: You won’t get it. Because the patient goes to a private clinic and gets it (P1, FG5)

Medication is easier, as if it were a miracle. But this miracle doesn’t happen [...] (CHA1, FG4)

Patients with depressive disorders tend to prefer medication because they believe in a faster response. In this context, medicalization transforms non-medical experiences into illness³¹. In psychiatry, this is especially reflected in the medicalization of emotional experiences, functioning as a mechanism of social control that induces the individual to play the “sick person role” and compromise their personal autonomy³².

This process expresses the consolidation of biological psychiatry, strengthened by its articulation with the pharmaceutical industry, which establishes medication as the central axis of care and expands the medicalization of experiences, which are converted into mental illness³³. Thus, psychotropic drugs become the primary - and often exclusive - response to psychological suffering³⁴. Pacciulio³⁵, in an experience report, found that there were no records of non-drug therapies and that prescriptions were continuously renewed without reassessment, evidence of the medicalization of symptoms without a thorough diagnostic investigation.

The use of medications as an immediate response to psychological suffering, as mentioned by the participants, reveals that the prescription of psychotropics is not based on a careful assessment and shows the fragility of clinical follow-up, characterized by the absence of therapeutic planning, periodic reassessments, and drug discontinuation strategies. This configures a care model focused on containing symptoms rather than on implementing a broader multidisciplinary approach. This dynamic is illustrated by the following statements:

The person has a minor anxiety attack or is sad and is immediately medicated. (P2, FG5)

[...] it’s about containing the symptom rather than understanding what is happening. (SW, FG5)

[...] What I see most is an indiscriminate use, just to sedate and sleep, without treating the underlying cause. (Do2, FG3)

[...] the medical record needs to be at least briefly reviewed, but some records don’t have much information. So it’s just the doctor’s decision, whether the prescription will be renewed or not, or whether to ask the patient to schedule an appointment. (P2, FG5)

Furthermore, the professionals mentioned that the treatment is not systematically monitored:

There’s no plan to taper the medication; it’s just started and continued. (P1, FG5)

When medication is naturalized as the response to suffering, care goes beyond the institutional space and socially legitimizes its use, favoring self-medication³⁶. Self-medication, as a practice constructed in users’ daily lives, is characterized by the use of medications without the prescriber’s counseling and the mediation of other professionals who compose the health care monitoring network³⁷. Such use is intensified by media influence and fragmented information, resulting in inappropriate drug combinations³⁸. In the study, self-medication was reported as a common practice:

[...] there’s that thing that seems to be a joke, but it isn’t [...] they get medicine from the neighbor, the uncle, the brother, and then they come here and ask me: “Can you make two prescriptions of this medicine? I have to give back the medicine my mother gave me”. (Do1, FG3)

It is fundamental to raise awareness regarding self-medication of psychotropic drugs and responsible use of these medications, which must be restricted to cases where they are truly necessary³⁹. The rational use of medications and the prevention of self-medication should be priorities for health teams, as this practice is one of the main causes of drug poisoning. To this end, it is essential to systematize poisoning data, implement integrated public policies in the areas of education, regulation, and mental health, and ensure the provision of counseling by qualified professionals^27,40.

In light of this scenario, the professionals highlighted the importance of including pharmacists in the teams and implementing the pharmaceutical consultation room as strategies to improve patient counseling, strengthen the rational use of medications, and expand clinical follow-up:

We really need a district pharmacy; we need to have a pharmaceutical consultation room so that after the patient leaves the doctor’s office, they receive counseling to ensure they understand the instructions. We have a demand that overloads everyone, so the nursing staff won’t always note that the patient hasn’t understood the instructions given in the doctor’s office, and then the patient will start the treatment in the wrong way. (NT, FG4)

In this context, users’ systematic follow-up is fundamental for treatment reassessment, adherence monitoring, and continuous clarification of instructions. These are central dimensions of pharmacotherapeutic care that are poorly structured in the daily routine of services. This gap was repeatedly mentioned by the participants:

It would be ideal to have follow-up, to have monitoring [...] but we don’t. (NT, FG1)

[...] the right thing would be to have other professionals reviewing the medication instructions, to see if the patient understood [...] to have a review routine. (N, FG4)

In light of the reports transcribed here, it is necessary to understand the pharmacy as a health service integrated into care processes, in which access to medications is linked to the promotion of rational use⁴¹. In this arrangement, the pharmacist plays a strategic role in improving mental health care, particularly in patient counseling and in raising awareness among prescribers regarding more appropriate therapeutic choices⁴². Their work contributes to reducing dispensing errors, strengthening patient safety, and increasing treatment adherence⁴³. These findings, corroborated by international studies, reinforce the importance of including a pharmacist in the health team to improve the care provided for depressed patients^44,45.

Polypharmacy and therapeutic duplication

Polypharmacy, defined as the concomitant use of multiple medications, usually five or more⁴⁶, was frequent among depressed users:

These are patients with many comorbidities and they take a lot of medications that can interact with each other. (Do1, FG4)

Some psychiatrists practice polypharmacy, prescribing drugs of all classes and more than one of the same class, for cases that you don’t even understand why. And it wasn’t just with one or two, it was with several users that this happened. (P2, FG5)

Psychotropic polypharmacy, characterized by the simultaneous use of two or more psychotropics, has been intensified in PHC, reflecting the centrality of drug prescription as a response to psychological suffering^47-49. It is associated with the underutilization of non-pharmacological strategies, lack of guidelines, limited training, and scarcity of investments⁵⁰.

Another critical aspect identified in the study was the occurrence of drug interactions, frequently neglected in clinical follow-up:

Interactions between two different medications frequently occur, and it is believed that this is due to my colleagues failing to explain that if the patient is taking this medication, they shouldn’t take the other. (Do1, FG3)

[...] I once questioned the psychiatrist who was treating him (the patient) about the medications he was taking: Diazepam, Alprazolam, and Duloxetine: “Look, Doctor, I didn’t understand the reason for prescribing two benzodiazepines”. (Do, FG2)

The data showed a recurrent prescription of psychotropic drugs with a high interaction potential, which raises treatment risks, as a greater number of drugs is directly associated with a higher occurrence of interactions and adverse reactions⁵¹. In this scenario, the irrational use of psychotropic drugs in the public network is frequent and requires integrated strategies involving prescribers, pharmacists, and patients. Rational prescribing, treatment monitoring, and ongoing studies on medication use are essential to prevent abuse and promote the safe and effective use of these drugs⁵².

The concomitant administration of medications requires monitoring, especially in older adults⁵³. A cross-sectional study conducted in a municipality in the state of Paraíba found that benzodiazepines prescribed by general practitioners were the most frequently used psychotropic medications in PHC. Most drug interactions identified in the prescriptions were of moderate to high severity, with the combination of Alprazolam and Diazepam classified as severe due to the increased risk of central nervous system depression⁵⁴. The combination of these drugs with Duloxetine intensifies the risks to user safety, especially due to the potential for sedation^55,56.

The prescription of antidepressants should overcome the biomedical approach and incorporate users’ life contexts. Attention to prescription incompatibilities and interprofessional communication are central to patient safety. Treatment adherence, understood as a relational process, can be strengthened through health education, multiprofessional review of the prescription, and psychosocial support, particularly if symptoms persist and polypharmacy is practiced^57-59.

Another relevant aspect highlighted by the professionals refers to therapeutic duplication, which is also related to polypharmacy. Therapeutic duplication occurs when the patient receives two or more medications from the same pharmacological class, or medications with the same mechanisms of action, from different professionals. Therapeutic duplication also occurs when a medication is repeatedly prescribed by the same professional^58-62.

In many situations, the occurrence of therapeutic duplication was observed at the moment of prescription renewal, often conducted remotely, as shown by the participants’ reports:

The use of multiple medications happens because patients consult different doctors in different places: the cardiologist prescribes one thing, the psychiatrist another, and the endocrinologist something else. (Do, FG2)

In most teams, renewal occurs remotely. In some, the unit’s doctor renews the prescription; in others, this happens in the secretary’s office, where a doctor on duty renews it but doesn’t know the user. (P2, FG5)

According to the reports from the focus group participants, therapeutic duplication is frequent in depressed patients using more than two psychotropic drugs, sometimes from the same class, leading to drug interactions, overdose, and a high risk of health damage.

In the daily routine of health care units, prescription renewal without clinical assessment was observed in users with chronic conditions taking psychotropic drugs. This practice, identified in the present study, is also mentioned in the literature, suggesting challenges in the longitudinal follow-up of patients⁶³. The continuous use of medications without medical assessment and without the use of protocols can generate risks of adverse events and harm users’ health⁶⁴. According to Medeiros Filho et al.⁶⁵, lack of assessment by a medical professional generates social medicalization, as some users of psychotropic drugs attend the appointment only to obtain the renewal, due to the trivialization of prescribing.

Reducing repeat prescribing in PHC is of paramount importance, as this can prevent medication-related harm^66,67. In PHC, monitoring medication use is fundamental to ensure care safety, as repeat prescribing can lead to duplications, documentation failures, and dosing errors, with negative impacts on services and the health of users - particularly older adults, who are more vulnerable to polypharmacy and comorbidities⁶⁸.

The findings point to weaknesses in prescription renewal, which is often automatic and without adequate assessment, compromising the comprehensiveness of care. Deficiencies in pharmacotherapeutic follow-up, polypharmacy management, and the provision of instructions increase risks, weaken the patient-professional relationship, and favor treatment interruption, expressed in the discontinuation of antidepressant use.

Discontinuation of antidepressant use

Discontinuation of antidepressant use was identified as a recurring problem in PHC, with repercussions that go beyond a simple treatment interruption. It is associated with difficulty in understanding instructions, side effects, financial limitations, and the living conditions of users, particularly of vulnerable older patients. In this group, adherence is compromised by confusion regarding the correct use of medications, fragility of self-care, lack of family support, and fragmentation of care, which weakens the relationship with the team and hinders therapeutic continuity.

[...] a confused older patient comes and says: “I went to the pharmacy and they didn’t give me the medication”. Then I say: “No, sir! You can pick up the medication starting on [a specific date]”. He ran out of medications before the date because he has been taking them incorrectly. As he lives alone, we can’t understand his daily life, we don’t have 24-hour access, nor a relative to take responsibility for it. (Do, FG2)

Today I received a mental health patient who had recently been discharged from hospital; both the patient and her relative were confused by the medication instructions; there might be something delaying and preventing self-care, but the confused patient went to the pharmacy, confused by the instructions, then came to the unit and we couldn’t understand, the patient was from the CAPS [Psychosocial Care Center], which had also failed to provide instructions; the patient came to the unit twice, had three consultations, and I don’t know how things ended up. (E, FG4).

Low adherence is recognized as one of the main challenges of mental health care in PHC, especially in contexts marked by polypharmacy and difficulties in daily follow-up:

Many errors occur because the patient didn’t understand how to take the medication, or think they shouldn’t take it every day and start to have a crisis. Everyone is overmedicated; there isn’t a patient who takes just one drug. Adherence is the main problem and that’s why we emphasize it so much, but it’s a utopia. (NT, FG4)

The lack of understanding regarding pharmacotherapy, identified across different professional groups in the present study, is a central element in the occurrence of errors related to medication administration and in the weakening of treatment adherence. This difficulty involves users, family members, and health care teams. The latter face limitations in building communication and organizational conditions capable of promoting self-care, particularly among vulnerable older adults. This affects therapeutic continuity and the relationship with services.

A cross-sectional study conducted in a pharmacy of the Brazilian National Health System (SUS) found that 46.0% of the older patients presented insufficient understanding of the medical prescription, associated with level of schooling. These findings indicate that care should not be limited to explaining the prescription. It requires the shared construction of strategies considering users’ cognitive and socioeconomic conditions, with adequate communication, active verification of users’ treatment comprehension, and involvement of the support network, favoring safe use of medications and overcoming barriers such as forgetfulness, low level of schooling, and financial limitations⁶⁹. In addition, family participation is essential for adherence⁷⁰.

According to the participants, many users are unable to maintain the recommended therapy, discontinuing treatment mainly due to adverse reactions and side effects:

Patients treated with Amitriptyline complain of weight gain; this issue of side effects is very common. (Do, FG2)

They are very concerned about weight gain caused by medications; it’s their most frequent question, especially for women. We try to explain. Fluoxetine doesn’t affect weight that much; all selective inhibitors affect libido. (Do2, FG3)

Frequent and/or inappropriate use of antidepressants can generate adverse reactions, leading to discontinuation of therapy. The side effects generally reported by adults are sexual dysfunction and weight gain⁷¹. Half of the patients discontinue treatment in the first six months^72,73, frequently due to side effects such as sexual dysfunction, drowsiness, and fatigue⁷⁴.

In this context, it is essential to help patients understand that side effects tend to precede drug efficacy, and this adaptation period is crucial for the success of the treatment⁷⁵. Strategies such as shared decision-making, the establishment of individual goals, and continuous monitoring strengthen adherence to care⁷³.

Another relevant factor for treatment discontinuation relates to financial difficulties in acquiring prescribed medications, especially when these are not available in the public network:

They use them, but we depend on what the SUS offers. When you need a slightly different, more modern, more potent medication, not all patients can get it. (Do2, FG3)

Sometimes, we try to switch to newer drugs that aren’t available in the municipal pharmacy and, at some point, they run out of money and have to go back to what the pharmacy offers: older drugs that have more side effects; they can’t continue with the treatment. (Do3, FG3)

Poverty, low levels of schooling, and financial difficulties are among the main determinants of non-adherence to therapy^76,77. A national study identified a higher probability of non-adherence to pharmacotherapy among individuals in worse socioeconomic conditions and lacking free access to continuous-use medications. The cost of treatment compromises the family budget, favors discontinuation of the drug therapy, and increases expenses with outpatient care and hospitalizations⁷⁸.

In summary, the discontinuation of antidepressant use is a multifactorial phenomenon linked to clinical, communicational, organizational, and socioeconomic limitations. This reinforces the need for integrated strategies in PHC that strengthen patient-professional relationships, attentive listening, and the shared construction of care.

Final remarks

The study reveals the centrality of medicalization in the care of depressed patients in PHC, expressed by the abuse of psychotropic drugs, polypharmacy, therapeutic duplication, and discontinuation of treatment. These factors may be linked to errors in the prescription, administration, and dispensing of these drugs and reveal structural and organizational weaknesses in the care model, particularly in pharmacotherapeutic follow-up, professional-user communication, and the articulation of the care network, with direct repercussions on patient safety.

Drug prescribing, often conducted without planning, reassessment, or discontinuation strategies, has been prioritized in the care of psychological suffering to the detriment of multiprofessional approaches, normalizing the use of medications, increasing risks, weakening adherence, and favoring discontinuation of drug use, especially among socially vulnerable users.

Promoting the rational use of psychotropic drugs requires continuous longitudinal follow-up supported by multiprofessional teams, with integrated action by physicians, pharmacists, psychologists, nurses, and other PHC professionals. Health education targeted at users and their families is the central axis for strengthening adherence, preventing medication errors, and improving care safety.

Participants highlighted the need for strategies that take into account users’ social, emotional, and economic contexts, recognizing that mental health care goes beyond the biomedical dimension. Thus, it is essential to extend consultation time, offer therapeutic groups, social activities, health promotion actions and psychotherapy, and strengthen the Integrative and Complementary Health Practices (PICS) as alternatives or complements to drug treatment.

Finally, the implementation of these strategies requires continuous efforts to improve the SUS, focusing on funding, the continuous education of teams, and the strengthening of psychosocial care networks, all of these supported by managers’ commitment and professionals’ engagement to ensure more humane, comprehensive, and safe care.

It is expected that the findings of this study will contribute to improving care practices, reducing medication-related errors, and strengthening mental health promotion policies in PHC.

Acknowledgments

To the professionals of the Municipal Health Department of Sapucaia do Sul for their essential collaboration in the conduct of this research. To Professor Rafaela Schaefer for her valuable contributions to the manuscript, as well as to the committee members who examined the thesis that originated this study, whose comments substantially improved the article. Finally, we thank the reviewers for their careful reading and for their contributions, which enriched the final version of the article.

• Floriano FF, Pereira LC, Junges JR. Professionals' perception of the risks of medication use by patients with depressive disorders. Interface (Botucatu). 2026; 30: e260258 https://doi.org/10.1590/interface.260258
• Funding
  Fábio de Freitas Floriano received a scholarship from the Coordination for the Improvement of Higher Education Personnel (CAPES), under the Graduate Support Program for Community-Based Higher Education Institutions (PROSUC) – Modality II (Institutional Fee), process no. 88887.915434/2023-0.
• d
  Abbreviations specific to the Brazilian health system were kept in Portuguese (e.g., RAPS, CAPS), while abbreviations with established English equivalents (e.g., Primary Health Care – PHC) were translated.

Data Availability

The dataset supporting the results of this study was made available in SciELO Data and can be accessed in: https://doi.org/10.48331/SCIELODATA.UO92QF.

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Edited by

• Editor
  Rosana Teresa Onocko-Campos https://orcid.org/0000-0003-0469-5447

• Associated editor
  Robert Filipe dos Passos https://orcid.org/0000-0003-0900-4262

Publication Dates

• Publication in this collection
  22 May 2026
• Date of issue
  2026

History

• Received
  16 Sept 2025
• Accepted
  25 Feb 2026