Antidepressant Adherence Research Articles

Trajectories of antidepressant use after tamoxifen initiation among young and middle-aged women with breast cancer.

Antidepressant treatment patterns may change after women with breast cancer (BC) initiate tamoxifen, potentially impacting health outcomes. We characterized trajectories of antidepressant use after initiating tamoxifen among young and middle-aged women with BC, identifying risk factors for trajectory group membership. A retrospective cohort included women 18-64years-old with BC and antidepressant treatment history who received a new tamoxifen dispensing (index date). We measured longitudinal antidepressant use post-index date as 12, monthly, proportion of days covered (PDC) measurements in a 25% random sample of IQVIA PharMetrics® Plus for Academics US claims, 2006-2022. Group-based trajectory models identified latent subgroups of antidepressant use by testing 2-6-group representations; the best model fit determined by the lowest Bayesian Information Criterion, clinical interpretability, and each subgroup comprising ≥ 5% of the cohort. Using multinomial logistic regression, baseline covariates including demographics, depression status and the CYP2D6-inhibitory strength of antidepressants were evaluated as risk factors for the trajectory of antidepressant use after tamoxifen initiation. Our sample of 851 women followed four distinct antidepressant adherence trajectories after tamoxifen initiation: 12% exhibited immediately decreasing use [mean PDC (sd) 8% (± 7)]; 7% exhibited delayed decreasing use [41% (± 14)]; 20% exhibited dynamic-moderate use [54% (± 15)]; and 60% exhibited consistently high use [91% (+ 7)]. Age, depression, and treatment with non CYP2D6-inhibiting antidepressants were associated with women's trajectory of antidepressant use after initiating tamoxifen. Nearly 40% of women were nonadherent to antidepressants after tamoxifen initiation. Future research should explore cancer-related and mental health implications of this nonadherence.

Antidepressant adherence among outpatients with major depressive disorder

Major Depressive Disorder (MDD) is a global mental health concern, with treatment often involving antidepressant (AD) medications. However, adherence to these medications remains a significant challenge. This study aims to investigate the factors influencing medication adherence among individuals with MDD in Erbil, Iraq. This study was conducted at Erbil Psychiatric Hospital, a leading mental healthcare facility in Erbil city. Participants aged 18 to 65, diagnosed with MDD as per the DSM-5 criteria, were treated with antidepressants. The recruitment of 106 participants was facilitated by their treating psychiatrists at the hospital. Data analysis was conducted using SPSS version 22, standard for social science research. Out of the 106 participants, 64.2% were females, and 35.8% were males. The largest age group was 35–45, comprising 33% of the sample. A vast majority (99.1%) were under regular follow-up, with only 0.9% experiencing relapse. The primary antidepressant used was selective serotonin reuptake inhibitors (SSRIs) (72.6%). Most participants (61.3%) reported very high medication adherence. The notable barriers included treatment duration (13.4%), forgetting to take antidepressants (11.9%), frequent medication refills (17.9%), cultural and religious beliefs (19.3%), stigma (19.3%), travelling issues (42.9%), and lack of hospitals and clinics (30.8%). Healthcare facilitators such as effectiveness of antidepressants (27.5%), patient-provider relationship such as trusting healthcare providers (50.7%), and reminders such as keeping pills in visible places (65.9%) were prominent facilitators aiding adherence. Future research should focus on culturally tailored interventions and collaborative efforts among stakeholders. By addressing socio-cultural nuances and enhancing mental health support, more effective strategies can be developed to tackle medication adherence challenges in Erbil’s unique context.

Patient Characteristics and Adherence to Antidepressant Medication Treatment at PsychiatricOutpatient Department of Mardan Medical Complex, Pakistan

Background: Adherence to antidepressant treatment is an important factor in the treatment and effective management of depressed patients. Characteristics of patients can help in determining compliance to treatment protocols. In order to find link between compliance and demographic characteristics of patients, insight can be obtained through exploration of these variables.Objectives: To determine the association between patient characteristics and antidepressant medication adherence. To identify characteristics of patients that may improve or worsen compliance to antidepressant medication. Material and Methods: This study was a descriptive, cross-sectional study aiming to find the link between personal characteristics and adherence to anti-depressant medications. The study was conducted at Psychiatry outpatient department of a tertiary care hospital, Mardan Medical Complex, Mardan Pakistan, from 05th September 2018 to 08th February 2021. Data was collected from 660 patients who presented with depressive symptoms to Psychiatry OPD. The main objective was to identify characteristics of patients leading to poor compliance to antidepressant medication. Results: Total study population was 660. Majority of the study population 82.9 % (n-549) were female. Uneducated were, 56.6 % (375), 81.1 % (n-537) were unemployed, and 65.9 % (n-436) were married. Follow up interviews were conducted in 316 (47.7 %) patients at 3rd week, 186 (28.1 %) patients at 6th week, 130 (19.6 %) patients at 9th week, 96 (14.5 %) patients at 12th week, and 31 (4.7 %) patients at 6 months. There was no significant difference found on the basis of patient characteristics and adherence. However, compliance was better among patients who had longer duration of illness. Conclusion: Medication adherence is a common problem among depressed patients and leads to impaired daily life functioning. Our study could not found any significant difference regarding patient characteristics among compliant and non compliant patients. Educating patients regarding the use of antidepressant medication treatment should be added to routine practice. Keywords: Anti depressants, Depression, Non-adherence, Poor compliance.

Patient Perceived Barriers and Enablers to Medication Adherence in the Treatment of Depression: A Qualitative Study.

Depression affects approximately 280 million individuals globally and it is a leading cause of disability. Despite effective medication options, 50% of patients prematurely discontinue antidepressants within 6 months. We sought to understand patients' perspectives regarding their needs and expectations related to antidepressants. To identify and describe enablers and barriers that influence adult patients' medication adherence in depression treatment and to explore patients' educational needs on initiating or continuing antidepressant therapy. Qualitative descriptive study was conducted using individual, semi-structured interviews of adult patients with depression who were prescribed an antidepressant within 3 months of study recruitment at an urban primary care clinic in Toronto, Canada. Thirteen participants were interviewed. Interviews were recorded and transcribed verbatim for inductive thematic analysis. Six themes emerged: safety and effectiveness of antidepressant, understanding of depression and its management, medication administration, healthcare experiences in the treatment of depression, and social influences and relationships. Barriers to adherence included adverse effects of antidepressants, preference for non-pharmacological therapies, uncertainty about therapeutic effects, and social stigma. In contrast, enablers were positive responses from antidepressants, fear of relapse, reminder aids, established routine, and a trusting patient-provider relationship. Participants desired access to reliable, evidence-based, and personalized educational information delivered through verbal, written, and digital formats to support antidepressant adherence. To overcome the identified barriers, educational strategies should involve both patients and their prescribers to identify patient-specific needs and treatment goals, engage in shared decision-making, and maintain consistent follow-up to support antidepressant adherence.

Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications.

There is a paucity of evidence on the association between satisfaction with quality of care and adherence to antidepressants. To examine the association between patient satisfaction with healthcare and adherence to antidepressants. A cohort study design was used to identify antidepressant users from the 2010-2016Medical Expenditure Panel Survey data, a national longitudinal complex survey study design on the cost and healthcare utilization of the noninstitutionalized population in the United States. The Consumer Assessment of Healthcare Providers and Systems were used to measure participants' satisfaction with access and quality of care, patient-provider communication and shared decision-making (SDM). Patients were considered satisfied if they ranked the quality of care at ≥9 (range: 0[worst]- 10[best]). Antidepressant adherence was measured based on medication refill and complete discontinuation. MEPS sampling survey-weighted multivariable-adjusted logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between satisfaction and adherence to antidepressants. We tested for the potential presence of reverse associations by restricting the analysis to new users of antidepressants. The roles of patient-provider communication and SDM on the satisfaction-adherence association were examined through structural equation models (SEM). Among 4,990 (weighted counts = 8,661,953) antidepressant users, 36% were adherent while 39% discontinued antidepressants therapy. Half of antidepressant users were satisfied with the healthcare received. Satisfied patients were 26% (OR = 1.26, 95%CI: 1.08, 1.47) more likely to adhere and 17% (OR = 0.83, 95%CI: 0.71, 0.96) less likely to discontinue, compared to unsatisfied antidepressant users. Patient satisfaction was also associated with higher odds (OR = 1.41, 95%CI: 1.06, 1.88) of adherence among a subgroup of new users of antidepressants. The SEM analysis revealed that satisfaction was a manifestation of patient-provider communication (β = 2.03, P-value<0.001) and SDM (β = 1.14, P-value<0.001). Patient satisfaction is a potential predictor of antidepressant adherence. If our findings are confirmed through intervention studies, improving patient-provider communication and SDM could likely drive both patient satisfaction and adherence to antidepressants.

Antidepressant Adherence in a Community Pharmacy Setting Before and After the Onset of the COVID-19 Pandemic

Antidepressant Adherence in a Community Pharmacy Setting Before and After the Onset of the COVID-19 Pandemic

Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial.

There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849.

Real-world outcomes of concomitant antidepressant and statin use in primary care patients with depression: a population-based cohort study

BackgroundAntidepressants are licensed for use in depressive disorders, but non-response and poor adherence to treatment affect a considerable number of patients. Pre-clinical and clinical evidence suggest that statins can augment the effects of antidepressants. However, the acceptability and tolerability of combining statins with antidepressants are unclear, and their add-on efficacy has only been shown in small, short-term clinical trials. Observational data can provide complementary information about treatment effects on larger samples over longer follow-ups. In this study, we therefore assessed the real-world acceptability, tolerability, and efficacy of concomitant antidepressant and statin treatment in depression.MethodsWe conducted a population-based cohort study investigating QResearch primary care research database, which comprises the anonymised electronic healthcare records of 35 + million patients over 1574 English general practices. Patients aged 18–100 years, registered between January 1998 and August 2020, diagnosed with a new episode of depression, and commencing an antidepressant were included. Using a between-subject design, we identified two study groups: antidepressant + statin versus antidepressant-only prescriptions.Outcomes of interest included the following: antidepressant treatment discontinuations due to any cause (acceptability) and due to any adverse event (tolerability) and effects on depressive symptoms (efficacy) measured as response, remission, and change in depression score on the Patient Health Questionnaire-9. All outcomes were assessed at 2, 6, and 12 months using multivariable regression analyses, adjusted for relevant confounders, to calculate adjusted odds ratios (aORs) or mean differences (aMDs) with 99% confidence intervals (99% CIs).ResultsCompared to antidepressant-only (N 626,335), antidepressant + statin (N 46,482) was associated with higher antidepressant treatment acceptability (aOR2months 0.88, 99% CI 0.85 to 0.91; aOR6months 0.81, 99% CI 0.79 to 0.84; aOR12months 0.78, 99% CI 0.75 to 0.81) and tolerability (aOR2months 0.92, 99% CI 0.87 to 0.98; aOR6months 0.94, 99% CI 0.89 to 0.99, though not long term aOR12 months 1.02, 99% CI 0.97 to 1.06). Efficacy did not differ between groups (range aOR2-12 months 1.00 and 1.02 for response and remission, range aOR2-12 months − 0.01 and − 0.02 for change in depression score).ConclusionsOn real-world data, there is a positive correlation between antidepressant treatment adherence and statin use, partly explained by fewer dropouts due to adverse events. The main limitation of our study is its observational design, which restricts the potential to make causal inferences.

Antidepressant continuation and adherence in pregnancy, and risk of antenatal hospitalization for unipolar major depressive and/or anxiety disorders

BackgroundKnowledge about the effectiveness of antidepressants in pregnancy is limited. We aimed to evaluate the association of antidepressant continuation in pregnancy and adherence with the risk of antenatal hospitalization for depression/anxiety. MethodsIn a population-based study based on the healthcare databases of the Lombardy region, Italy (2010–2020), we included 17,033 live-birth pregnancies within 16,091 women with antidepressant use before pregnancy. Antidepressant exposure was classified as continued in pregnancy versus discontinued proximal to pregnancy. Outcome measure was antenatal hospitalization for depression/anxiety. Propensity score matching analysis was performed to control for measured confounding. Stratification by pre-pregnancy antidepressant adherence based on the proportion of days covered (PDC) with antidepressants served to address confounding by disease severity. We applied 60 days lag-time for antidepressant exposure to minimize the risk of protopathic bias. ResultsThere were 362 (2.1 %) antenatal hospitalizations for depression/anxiety. Among the matched pairs, the cumulative incidence was 3.5 (continued antidepressant) versus 2.1 (discontinued antidepressant) per 1000 person-months, yielding a hazard ratio (HR) of 1.76 (95 % confidence interval (CI): 1.34–2.33)). The HR declined to the null (1.02, 95 % CI: 0.62–1.69) in the stratified analysis of pregnancies with moderate-high adherence pre-pregnancy. Moderate-high adherence in pregnancy was associated with 85 % greater risk of the antenatal outcome, but the HR decreased with the 60 days lag-time (HR: 1.40, 95 % CI: 0.79–2.50). LimitationsLack of information regarding antidepressant dosage. ConclusionWe found no difference in risk for antenatal hospitalization for depression/anxiety with antidepressant continuation or higher adherence in pregnancy, relative to discontinuation or lower adherence.

Antidepressant adherence trajectory before cancer diagnosis and risk of antidepressant discontinuation after cancer diagnosis among middle-aged US adults.

e18890 Background: For middle-aged adults taking antidepressants before cancer diagnosis, concerns exist about drug-drug interactions between antidepressants and antineoplastics. Clinical guidelines recommend detailed assessment of the new cancer survivor's past history of antidepressant use before considering antidepressant discontinuation. We aimed to determine whether, in real-world settings, the risk of antidepressant discontinuation after cancer diagnosis is associated with survivors’ past antidepressant adherence trajectories. Methods: A retrospective cohort of 45 to 64-year old individuals with incident cancer diagnosis (index date) and ≥2 antidepressant fills in the 9 months before index date, IQVIA PharMetrics Plus for Academics claims, 2006-2020. Antidepressant adherence in the 9-month baseline was measured as monthly proportion of days covered (PDC) before tamoxifen initiation. Group-based trajectory modeling (GBTM) was used to identify clusters of survivors with distinct antidepressant adherence trajectories pre-index date i.e., we calculated polynomial functions of monthly PDCs and compared 2 to 6-group finite mixture models to determine which model best fit the data, based on the Bayesian Information Criterion, expert-adjudged parsimony and ≥10% of the sample in each trajectory group. Antidepressant discontinuation after cancer diagnosis was defined as a 45-day gap in antidepressant supply. Survivors were censored at first of either antidepressant discontinuation, loss of enrollment or 1 year post-index date. Cox regression compared the hazard of antidepressant discontinuation by trajectory group, adjusted for demographics, mental disorder and cancer type. Results: We identified 7,293 middle-aged cancer survivors with prior antidepressant use; females 72%, mean age (SD) 56 (7) years. GBTM identified 4 adherence trajectory groups (consistently high, steady increase, declining, and recent start); metastatic cancer being characteristic of the latter 3 groups relative to the consistently high group. Antidepressant discontinuation was lowest in the consistently high group (26% [mean months-to-discontinuation: 9]) and highest in the declining (68% [5]) and recent start (51% [6]) groups, p &lt; .01. Hazard ratios [95% CI] of discontinuation were significantly higher in the declining (2.7 [2.3 – 3.2]), recent start (1.9 [1.7 – 2.0]) and steady increase (1.5 [1.4 – 1.6]) groups, relative to the consistently high group. Conclusions: Middle-aged cancer survivors with past trajectories of consistently high adherence to antidepressants experience lower risk of antidepressant discontinuation after cancer diagnosis in real-world practice. However, concern remains about the unintended health outcomes of relatively higher antidepressant discontinuation among survivors diagnosed with metastatic cancer.

0477 Positive Airway Pressure Therapy and Antidepressant Medication Adherence in Patients with Obstructive Sleep Apnea and Depression

Abstract Introduction Previous studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with OSA and comorbid depression may improve response to antidepressant medication therapy. At the same time, scant evidence has examined the impact of medication and PAP adherence in patients with OSA and comorbid depression. Patients that adhere to one therapy may be more likely to adhere to other therapies or healthy behaviors in a so-called “healthy user effect.” This retrospective study investigated the association between antidepressant medication adherence and PAP therapy adherence in patients with newly diagnosed OSA and comorbid depression. Methods Our data source was a national sample of administrative claims data linked to objective PAP therapy usage. Included patients either had two healthcare encounters or one hospitalization with a depression ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. Adherence to antidepressant medication was defined as ≥80% of proportion of days covered (PDC), and non-adherence was defined as &amp;lt; 80% PDC within a 180-day exposure window during the year prior to starting PAP therapy. Adherence to PAP therapy was categorized as consistently adherent, intermediately adherent, or not adherent based on objective usage over 2 years. Results 36,668 patients with OSA and comorbid depression were included. 27% were classified as consistently adherent, 45% intermediately adherent, and 28% non-adherent to PAP therapy. 68.6% of patients used antidepressant medication in the year prior to PAP initiation. 67.7% used a selective serotonin reuptake inhibitor, 43.8% atypical antidepressants, 32.1% serotonin and norepinephrine reuptake inhibitor, 10.7% tricyclic antidepressant, and 0.1% monoamine oxidase inhibitor. Relative to patients not adherent to antidepressant medication (22.2% consistently adherent, 43.8% intermediately adherent, 33.9% not adherent), those adherent to antidepressant medication in the year prior were also more adherent to PAP therapy over 2 years (29.2% consistently adherent, 45.2% intermediately adherent, 25.6% not adherent). Conclusion Patients that were adherent to antidepressant medication in the year prior to starting PAP therapy have slightly better adherence to PAP therapy over 2 years. In real-world studies, medication adherence may be an important confounder to adjust for when comparing patient outcomes. Support (if any)

Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD.

This work aimed to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with posttraumatic stress disorder (PTSD). Veterans with PTSD (N=227) participating in a multicenter trial were randomly assigned to receive a service or emotional support dog; 181 veterans received a dog and were followed up for 18 months. Primary outcomes included overall functioning (assessed with World Health Organization Disability Assessment Scale II [WHODAS 2.0]) and quality of life (Veterans RAND 12-Item Health Survey [VR-12]). Secondary outcomes included PTSD symptoms (PTSD Checklist for DSM-5), suicidal ideation, depression, sleep quality, health care costs and utilization, medication adherence, employment, and productivity. Participants paired with a dog had a mean±SD age of 50.6±13.6 years (range 22-79), and most were male (80%), White (66%), and non-Hispanic (91%). Adjusted linear mixed repeated-measures models indicated no difference between the two groups on WHODAS 2.0 or VR-12 scores. Participants with service dogs had a 3.7-point greater reduction in PTSD symptoms versus participants with emotional support dogs (p=0.036). No reduced health care utilization or cost was associated with receiving a service dog. Veterans with service dogs had an increase of 10 percentage points in antidepressant adherence compared with those with emotional support dogs (p<0.01). Both groups appeared to benefit from having a service or emotional support dog. No significant differences in improved functioning or quality of life were observed between the groups. Those in the service dog group had a greater reduction in PTSD symptoms and better antidepressant adherence, improvements that should be explored further.

Adherence to augmentation therapy for the treatment of major depressive disorder

ABSTRACT Background Inadequate response to antidepressant medication is common. Often, adjunctive pharmacotherapy or psychotherapy is recommended. Objective To measure adherence to adjunctive pharmacotherapy and psychotherapy among individuals with major depressive disorder (MDD). Methods Retrospective cohort study of individuals with MDD on antidepressant monotherapy who added adjunctive pharmacotherapy and/or psychotherapy. Medication adherence was measured by proportion of days covered (PDC) with optimal adherence defined as PDC≥0.80 and psychotherapy adherence defined by count of visits (optimal 8+ visits). Factors associated with optimal adherence were assessed by logistic regression. Results Among 218,192 individuals with adjunctive therapy, 185,349 added pharmacotherapy and 32,843 added psychotherapy. In the subsequent 12 months, 36.2% and 54.9% achieved optimal adherence to adjunctive pharmacotherapy and psychotherapy, respectively. Adherence to adjunctive pharmacotherapy was associated with adding psychotherapy, index antidepressant adherence, medical comorbidities, and MDD severity codes. Adherence to adjunctive psychotherapy was associated with adding another medication, previous psychiatry visit and psychiatric comorbidities. Conclusion Adjunctive psychotherapy appears under-utilized and adherence to adjunctive therapy was low. Low adherence to adjunctive therapy reinforces challenges in managing MDD. That a second adjunctive therapy enhanced adherence to the initial adjunctive therapy indicates an opportunity to explore alternative adjunctive therapies.

Psychosocial interventions to improve adherence in depressed and anxious older adults prescribed antidepressant pharmacotherapy: a scoping review.

Medication nonadherence in depressed and anxious older adults is prevalent and associated with non-response to antidepressant pharmacotherapy. Evidence-based options to improve medication adherence are limited in this population. To review the state of the literature on the types and efficacy of psychosocial interventions for improving antidepressant pharmacotherapy adherence in depressed and anxious older adults. We conducted a scoping review according to PRISMA-ScR guidelines. PubMed/Medline and article references starting in 1980 up to 28 February 2023 were reviewed. Of the 710 records screened, 4 psychosocial interventions were included in the review. All studies included depressed older adults, and none included anxious older adults. Samples included racial and ethnic minorities and were primarily women. The psychosocial interventions consisted mainly of psychoeducation with usual care as the control comparison. Measures of antidepressant adherence included self-reported adherence or pill counting. Three of the four randomized controlled trials improved medication adherence rates and reduced depression symptom burden. Effective interventions exist for improving antidepressant medication adherence in depressed older adults. Improved adherence can reduce depression symptom burden. The lack of interventions for anxious older adults highlights the need to develop and deliver interventions for anxious older adults prescribed antidepressant pharmacotherapy.

Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model [Letter

Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model [Letter

Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model.

We report on antidepressant (AD) adherence among Hispanics seeking mental health services in a community primary care clinic in Texas as an ancillary outcome from a National Institutes of Health-funded study that collected data on Hispanic AD adherence over a period of two years (February 2016-February 2018). Adherence to AD medications was measured throughout the year-long trial and compared across various demographic characteristics. Since Hispanic individuals often experience stigma and cultural barriers related to AD treatment, we sought to understand what factors may increase the likelihood of non-adherence in this population. This study focused on 69 patients who were prescribed AD medications while receiving treatment through an integrated health care model. Adherence was measured with the Patient Adherence Questionnaire, a validated 2-item questionnaire that asks patients about their medication use (missed medications or dosage changes) over the past week. We looked at patient adherence at two key time points (4-weeks and 13-weeks) and utilized logistic regression to identify factors that may increase or decrease the likelihood of adherence in Hispanic patients at a community primary care clinic. Non-adherence to AD medication was 49.3% at 4-weeks and 57% at 13-weeks post-treatment initiation. Logistic regression analyses revealed that age was the only significant predictor of AD non-adherence. As age increased, the likelihood of adherence increased by 12.2% at 13-weeks post-treatment initiation and by 11.1% at 4-weeks post-treatment initiation. The likelihood of Hispanic patients to adhere to AD therapy increased with the age of the patient. Since primary care is the most likely place to be prescribed an AD for Hispanic patients, further research to better understand adherence is essential. Integrated health care interventions designed to help identify, reduce, or eliminate barriers to adherence and improve cultural understanding may help address issues of non-adherence in primary care settings.

The effect of initial antidepressant type on treatment adherence in outpatients with new onset depression

BackgroundContinuous use of antidepressants can relieve depressive symptoms and prevent recurrence in people with depression; however, many studies have reported low drug compliance rates. This study aimed to investigate the relationship between the type of initial antidepressants and treatment adherence in outpatients with new onset depression. MethodsThis was a retrospective cohort study using National Health Insurance claim data for services provided in 2012. We examined data from 142,336 individuals aged 18 years or older, who were continuously enrolled in treatment after a new episode of depression, and had initiated antidepressant treatment. A new diagnosis of depression, is defined as a first reported diagnosis of depression in the preceding five years. Adherence was operationally defined as the antidepressant being dispensed to the patient at least 80% of the time during the first three- and six-month treatment periods. To investigate the relationship between the initial type of antidepressants and treatment adherence, we estimated adjusted odds ratios and 95% confidence intervals using logistic regression analysis, adjusting for socio-demographic and health care utilization characteristics. ResultsA statistically significant association was found between initial antidepressant type and adherence in the first three- and six-month treatment periods for employed and self-employed patients newly diagnosed with major depression. In addition, patients with starting prescriptions for tricyclic antidepressants had significantly lower adherence compared to selective serotonin reuptake inhibitors. LimitationsThis study used national insurance data; therefore, only variables on the claim form were available, and psychological and environmental factors were not considered. ConclusionsThis was the first study to demonstrate the relationship between initial antidepressant type and treatment adherence among Korean outpatients with new onset depression.

Predicting Medication Nonadherence in Older Adults With Difficult-to-Treat Depression in the IRL-GRey Randomized Controlled Trial

Nonadherence to antidepressants interferes with optimal treatment of late-life depression. This analysis examines clinical and treatment factors predicting medication nonadherence in difficult-to-treat late-life depression. Secondary analysis of data from a clinical trial of antidepressant pharmacotherapy for Major Depressive Disorder in 468 adults aged 60+ years. All participants received venlafaxine XR for 12 weeks. Nonremitters were randomized to augmentation with either aripiprazole or placebo for 12 additional weeks. Medication adherence was assessed 14 times over 24 weeks. The analyses examined sociodemographic, clinical, and treatment factors that may predict antidepressant nonadherence during early (weeks 1-6), late (weeks 7-12), and augmentation (weeks 13--24) treatment. Poor cognitive function and early response were predictive of early nonadherence. Poor cognitive function and prior nonadherence were predictive of late nonadherence. Living alone was associated with nonadherence both late and during augmentation treatment. Future studies should consider the role of early response and cognitive function to improve antidepressant adherence, particularly among older adults who live alone.

Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population-based study.

SummaryBackgroundDespite high rates of depression and anxiety, little is known about the use of antidepressants amongst individuals diagnosed with inflammatory bowel disease (IBD).AimsTo evaluate temporal trends in the use of antidepressants; rates of antidepressant initiation and adherence of antidepressant use to international guidelines amongst individuals with IBD.MethodsThis is a study of 14,525 incident IBD cases from 2004 to 2016 compared with 58,027 controls matched 1:4 for age and sex from the Clinical Practice Research Datalink. After excluding tricyclic antidepressants, we performed a Cox regression analysis to determine the risk associated with antidepressant use and logistic regression analysis to determine risk associated with antidepressant undertreatment.ResultsAntidepressant use amongst individuals with IBD increased by 51% during the 12‐year study period, who were 34% more likely to initiate antidepressants in the year after IBD diagnosis compared with controls (aHR:1.34, 95% CI 1.21‐1.49). In those with IBD starting antidepressants, 67% received treatment lasting less than the duration recommended in international guidelines, of which 34% were treated for 1 month or less.18‐24 year olds were twice as likely to discontinue treatment within 1 month compared with those aged 40‐60 years (aHR:2.03, 95% CI 1.40‐2.95). Socioeconomic deprivation was also associated with early treatment discontinuation (aHR:1.40, 95% CI 1.07‐1.83).ConclusionsIn the year following IBD diagnosis individuals are significantly more likely to start antidepressants compared with controls, but treatment duration fell short of recommendations in the majority. Better integration of services may benefit individuals with IBD and psychiatric comorbidity.

Generics and Biosimilars: Barriers and Opportunities

Generics and Biosimilars: Barriers and Opportunities