Patient adherence in the treatment of depression

Abstract

Background: Non-adherence with antidepressant treatment is very common. Increasing adherence to pharmacological treatment may affect response rate. Aims: To review and summarise quantitative evidence on factors associated with adherence and of adherence-enhancing interventions. Method: A systematic review of computerised databases was carried out to identify quantitative studies of adherence in depression. Papers retained addressed unipolar depression and considered adherence as the primary end-point. Results: Of studies published between 1973 and 1999, 32 met the review criteria: epidemiological descriptive studies (n=14); non-random comparisons of control and intervention groups (n=3); randomised interventions (n=14); and meta-analysis (n=1). Patient education and medication clinics were the interventions most commonly tested, combined with a variety of other interventions. Conclusions: The studies did not give consistent indications of which interventions may be effective. Carefully designed clinical trials are needed to clarify the effect of single and combined interventions. Declaration of interest: The study was partially supported by Centro Studi e Ricerche in Psichiatria,Turin; Istituto Superiore di Sanità, Rome; and Ravizza Pharmaceuticals, Milan.