title: Working with reactant patients: are we prescribing nonadherence?
abstract: OBJECTIVE
  In spite of high levels of antidepressant nonadherence frequently observed among depressed samples, relatively little research has investigated psychosocial predictors of adherence. Fostering greater collaboration in depression treatment to increase adherence has been advocated, but this strategy has not been adequately studied. The aim of this study was to examine the interaction of provider collaboration and patient reactance in the prediction of antidepressant adherence during the acute treatment phase.
  
  
  METHODS
  Fifty outpatients diagnosed with major depressive disorder beginning antidepressant treatment within psychiatry clinics of the VA San Diego Healthcare System comprised the study sample. Patients were administered questionnaires following their medication evaluations to measure predictor variables. Antidepressant adherence was assessed via brief telephone interviews 3, 6, 9, and 12 weeks after treatment initiation. The roles of provider collaboration, patient reactance, and their interaction in adherence were examined using multiple regression analyses.
  
  
  RESULTS
  The interaction between provider collaboration and patient reactance accounted for 18.3% of the variance in 3-week adherence (P<.01). Among more reactant patients, greater levels of collaboration predicted better adherence, whereas among patients lower in reactance less collaboration predicted better adherence. No relationships were observed beyond the initial 3 weeks of treatment.
  
  
  CONCLUSIONS
  This study demonstrates that interpersonal process variables are important in influencing antidepressant adherence and challenges the advocacy of more collaboration in antidepressant treatment as a "blanket strategy." Establishing a more collaborative set with reactant patients may ensure greater early treatment adherence, a critical period during which antidepressants have typically not yet taken effect.
authors.affiliation: Psychology Service, VA San Diego Healthcare System, La Jolla, California 92161, USA. joshua.madsen@va.gov
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Madsen
authors.forename: John R
authors.initials: JR
authors.lastname: McQuaid
authors.forename: W Edward
authors.initials: WE
authors.lastname: Craighead
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003142:Communication; D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D017060:Patient Satisfaction; D010555:Personality Inventory / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011594:Psychometrics; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents