Abstract
BackgroundAdherence to treatment, i.e. the extent to which a patient’s therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram.MethodsTwenty participants with moderate to severe depression were 1–1 randomized to either (1) 5 mg MPH + 10 mg escitalopram or (2) placebo + 10 mg escitalopram with the possibility for a dose increase at 4 weeks. A Bayesian analysis was conducted to evaluate the outcomes.ResultsFirst, neither percent Pill count nor Medication Electronic Monitoring System adherence showed that MPH was superior to placebo. In fact, placebo showed slightly higher adherence rates on the primary (7.82% better than MPH) and secondary (7.07% better than MPH) outcomes. There was a less than 25% chance of MPH augmentation showing at least as good or better adherence than placebo. Second, both groups showed a significant effect of treatment on the QIDS-SR with a median effect of an 8.6-point score reduction. Third, neither subjective measures of adherence attitudes nor socio-demographic covariates had a significant influence on the primary or secondary outcome variables.ConclusionsThese data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression.ClinicalTrials.gov identifierNCT03388164, registered on 01/02/2018.
Highlights
Adherence to treatment, i.e. the extent to which the patient’s history of therapeutic engagement coincides with the prescribed treatment [1], is among the most important problems in mental health care [2, 3]
It is estimated that nearly half of all prescribed medications are not taken, that about 125,000 deaths annually are attributable to non-adherence, and that non-adherence costs are estimated between $100 and $300 billion each year [4]
The current study aimed to investigate the influence of pairing a pharmacological agent with an acute positive reinforcing dopaminergic/noradrenergic effect with a standard antidepressant on the rates of medication treatment adherence
Summary
I.e. the extent to which the patient’s history of therapeutic engagement coincides with the prescribed treatment [1], is among the most important problems in mental health care [2, 3]. There are slight differences between antidepressant medication classes [13], but low adherence is not limited to medication treatment for depression [14], or even mental health [15, 16]. I.e. the extent to which a patient’s therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram
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