Journal
BRAZILIAN JOURNAL OF PSYCHIATRY
Volume 43, Issue 2, Pages 189-202Publisher
ASSOC BRASILEIRA PSIQUIATRIA
DOI: 10.1590/1516-4446-2020-0935
Keywords
Adherence; compliance; antidepressant; therapeutic drug monitoring; psychiatry; depression; mood disorders; treatment
Categories
Funding
- National Health and Medical Research Council (NHMRC) [1059660, 1156072]
- National Institutes of Health (NIH)
- Simons Autism Foundation
- Cancer Council of Victoria
- Stanley Medical Research Foundation
- MBF
- Medical Research Future Fund (MRFF)
- Beyond Blue
- Rotary Health
- Avant
- Harry Windsor Foundation
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Adherence to antidepressants is crucial for optimal treatment outcomes, but poor adherence is common among patients. Factors contributing to poor adherence include patient-related factors like age and comorbidities, as well as prescriber behavior-related factors like selection of poorly tolerated antidepressants. Multidisciplinary interventions and individually tailored antidepressant choice can improve adherence to antidepressants.
Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).
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