Adherence to Antidepressant Combinations and Monotherapy for Major Depressive Disorder
Autor: | Diane Warden, Sidney Zisook, David W. Morris, Alyson K Myers, Marisa Toups, Thomas J. Carmody, A. John Rush, Ira M. Lesser, Madhukar H. Trivedi, Kolette Ring Benji Kurian |
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Rok vydání: | 2014 |
Předmět: |
Adult
Male medicine.medical_specialty Mirtazapine Mianserin Citalopram Placebo Medication Adherence law.invention Placebos Randomized controlled trial Recurrence law Internal medicine medicine Humans Escitalopram Psychiatry Bupropion Depression (differential diagnoses) Depressive Disorder Major business.industry Venlafaxine Hydrochloride Middle Aged Cyclohexanols medicine.disease Antidepressive Agents Discontinuation Treatment Outcome Chronic Disease Major depressive disorder Antidepressant Drug Therapy Combination Female business medicine.drug |
Zdroj: | Journal of Psychiatric Practice. 20:118-132 |
ISSN: | 1538-1145 |
Popis: | 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. |
Databáze: | OpenAIRE |
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