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Journal of Psychiatric Practice:
doi: 10.1097/01.pra.0000445246.46424.fe
Articles

Adherence to Antidepressant Combinations and Monotherapy for Major Depressive Disorder: A CO-MED Report of Measurement-Based Care

WARDEN, DIANE PhD, MBA; TRIVEDI, MADHUKAR H. MD; CARMODY, THOMAS PhD; TOUPS, MARISA MD; ZISOOK, SIDNEY MD; LESSER, IRA MD; MYERS, ALYSON MD; KURIAN, KOLETTE RING BENJI MD; MORRIS, DAVID PhD; JOHN RUSH, A. MD

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Abstract

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. (Journal of Psychiatric Practice 2014;20:118–132)

© 2014 by Lippincott Williams & Wilkins, Inc.

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