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.