Issues in Adherence to Treatment With Monoamine Oxidase Inhibitors and the Rate of Treatment Failure

Issues in Adherence to Treatment With Monoamine Oxidase Inhibitors and the Rate of Treatment Failure

Lawrence J. Cohen, PharmD, BCPP, FASHP, FCCP, FCP, and David A. Sclar, BPharm, PhD

In 2000, the economic burden of depression in the United States was estimated to be $83.1 billion. Although many effective treatments are available and treatment rates have increased, response and remission rates for patients with depression remain low and multiple treatment trials are often required. Whether patients are adherent to their medication affects response and remission rates, and nonadherence is common among patients with depression. Increasing adherence improves treatment outcomes and lowers treatment costs. Interventions that increase adherence include educational, behavioral, affective, and provider-targeted strategies; transdermal delivery of drugs also may increase adherence by simplifying the patient’s medication regimen. While monoamine oxidase inhibitors (MAOIs) have proven efficacy for depression, particularly for patients with treatment-resistant or atypical depression, they are underprescribed due, in part, to concerns over dietary and drug restrictions that are required to avoid potential serious side effects. However, newer MAOI formulations, including a transdermal delivery system, have improved safety and tolerability profiles and avoid or lessen the need for dietary restrictions, giving clinicians another option for treating patients who may be nonadherent or nonresponsive to their current antidepressant.

(J Clin Psychiatry 2012;73[suppl 1]:31-36)

From the Department of Pharmacotherapy, the Department of Health Policy and Administration, and the Pharmacoeconomics and Pharmacoepidemiology Research Unit, Washington State University College of Pharmacy, Spokane (Drs Cohen and Sclar); the Washington Institute for Mental Health Research and Training, Spokane (Drs Cohen and Sclar); and the Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth (Dr Cohen).

This article is derived from the planning teleconference series "A Fresh Look at Monoamine Oxidase Inhibitors for Depression," which was held December 2011 through February 2012 and supported by an educational grant from Mylan Specialty L.P. (formerly known as Dey Pharma, L.P.).

Dr Cohen is a consultant for Dey and has received honoraria from and is a member of the speakers/advisory boards for Sunovion and Merck.

Dr Sclar is a consultant for and has received grant/research support and honoraria from Eli Lilly, Pfizer, GlaxoSmithKline, Forest, Dey, and Bristol-Myers Squibb and is a member of the speakers/advisory board for Eli Lilly.

Corresponding author: Lawrence J. Cohen, PharmD, BCPP, FASHP, FCCP, FCP, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107 (lawrence-cohen@att.net).

doi:10.4088/JCP.11096su1c.05

© Copyright 2012 Physicians Postgraduate Press, Inc.