Improving Adherence to Antidepressants: A Systematic Review of Interventions. [CME]
J Clin Psychiatry 2003;64(12):1415-1420
© Copyright 2016 Physicians Postgraduate Press, Inc.
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Background: Effectiveness of antidepressant
medication is reduced by patients' nonadherence. Several
interventions to improve adherence in patients diagnosed with
unipolar depression have been tested.
Objective: To systematically review the
effectiveness of interventions that aimed to improve adherence to
antidepressant medication in patients with unipolar depression.
Method: Systematic review of English-language
articles of randomized controlled trials obtained by a
computerized literature search of MEDLINE (1966-January 2002)
using the terms patient compliance, patient dropout, treatment refusal, patient education, adherence, clinical trial, randomized controlled trial, controlled
trial, depressive disorder, and depression;
PSYCINFO (1984-January 2002) using the terms random, clinical, control, trial, adherence, compliance, noncompliance, dropouts, patient education, depression, major depression, affective disorders, and dysthymic
disorder; EMBASE (1980-January 2002) using the terms patient
compliance, patient dropouts, illness behavior, treatment refusal, patient education, clinical
trial, controlled study, randomized controlled
trial, and depression; and the Cochrane Controlled
Trials Register (no restrictions) using the terms random*, complian*, adheren*, pharmacotherapy, regimen*, educat*, medicat*, depression, and depressive
Results: Educational interventions to enhance
adherence failed to demonstrate a clear benefit on adherence and
depression outcome. However, collaborative care interventions
tested in primary care demonstrated significant improvements in
adherence during the acute and continuation phase of treatment
and were associated with clinical benefit, especially in patients
suffering from major depression who were prescribed adequate
dosages of antidepressant medication.
Conclusion: We found evidence to support the
introduction of interventions to enhance adherence with
antidepressant medication in primary care, not only because of
better adherence but also because of better treatment results.
Because collaborative care interventions require additional
resources, a better understanding of the mode of action of
different programs is needed to reduce avoidable costs. The
effectiveness of educational interventions needs more evidence.