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

Diane Warden, Madhukar H. Trivedi, Thomas Carmody, Marisa Toups, Sidney Zisook, Ira Lesser, Alyson Myers, Kolette Ring Benji Kurian, David Morris, A. John Rush

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)118-132
Number of pages15
JournalJournal of Psychiatric Practice
Volume20
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Major Depressive Disorder
Carbon Monoxide
Antidepressive Agents
Citalopram
Pragmatic Clinical Trials
Therapeutics
Bupropion
Self Report
Outpatients
Placebos
Depression

Keywords

  • adherence
  • antidepressants
  • depression
  • discontinuation
  • implementation
  • medication combinations
  • persistence

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Medicine(all)

Cite this

Adherence to antidepressant combinations and monotherapy for major depressive disorder : A CO-MED report of measurement-based care. / Warden, Diane; Trivedi, Madhukar H.; Carmody, Thomas; Toups, Marisa; Zisook, Sidney; Lesser, Ira; Myers, Alyson; Kurian, Kolette Ring Benji; Morris, David; John Rush, A.

In: Journal of Psychiatric Practice, Vol. 20, No. 2, 2014, p. 118-132.

Research output: Contribution to journalArticle

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AU - Carmody, Thomas

AU - Toups, Marisa

AU - Zisook, Sidney

AU - Lesser, Ira

AU - Myers, Alyson

AU - Kurian, Kolette Ring Benji

AU - Morris, David

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