Adherence to antidepressant combinations and monotherapy for major depressive disorder: a CO-MED report of measurement-based care.

Journal Article (Journal Article)

BACKGROUND: Non-adherence to antidepressant treatment is not routinely measured in practical clinical trials. It has not been related to outcomes in a large sample of adults with chronic and/or recurrent major depressive disorder (MDD) or any sample treated with antidepressant combinations. METHODS: Adult outpatients with chronic and/or recurrent MDD were randomized to 12 weeks of treatment with bupropion-SR plus escitalopram, venlafaxine-XR plus mirtazapine, or escitalopram plus placebo. We compared non-adherence (the frequency with which daily medications were not taken) and specifically the frequency of temporarily stopping and/or skipping medication, or reducing or increasing the dose across treatments in 567 participants using a self-report questionnaire collected at each visit. We tested the association between non-adherence, and both treatment type and outcomes. RESULTS: A non-adherence rate under 10% was reported by 77.9%, 70.9%, and 71.6% of participants during weeks 1-4, 5-12, and 1-12, respectively. Antidepressant combinations were associated with a higher non-adherence rate than monotherapy during weeks 1-4 and 1-12. During weeks 1-4, 24.1% stopped/skipped doses and 6.1% reduced the dose. During weeks 5-12, 34.7% stopped/skipped doses and 9.4% reduced the dose. Across 12 weeks, 43.2% stopped/skipped doses, and 12.9% reduced the dose. Stopping/skipping doses during all time frames and dose decreases during weeks 1-12 occurred most frequently with combination treatments. Non-adherence was unrelated to symptom remission, response, or symptom change. CONCLUSIONS: With closely monitored treatment, non-adherence is low and unrelated to depressive symptom outcome. Nonadherence is highest with antidepressant combinations. Specific non-adherent events are most often sporadic.

Full Text

Duke Authors

Cited Authors

  • Warden, D; Trivedi, MH; Carmody, T; Toups, M; Zisook, S; Lesser, I; Myers, A; Kurian, KRB; Morris, D; Rush, AJ

Published Date

  • March 2014

Published In

Volume / Issue

  • 20 / 2

Start / End Page

  • 118 - 132

PubMed ID

  • 24638046

Electronic International Standard Serial Number (EISSN)

  • 1538-1145

Digital Object Identifier (DOI)

  • 10.1097/01.pra.0000445246.46424.fe

Language

  • eng

Conference Location

  • United States