Persistence and compliance to antidepressant treatment in patients with depression: a chart review.
BACKGROUND
Adherence has recently been suggested to be divided into these two components: persistence (i.e., whether patients continue treatment or not) and compliance (i.e., whether patients take doses as instructed). However, no study has yet assessed these two clinically relevant components at the same time in adherence to antidepressant treatment in the clinical outpatient setting.


METHODS
In this retrospective chart-review, 6-month adherence to antidepressants was examined in 367 outpatients with a major depressive disorder (ICD-10) (170 males; mean +/- SD age 37.6 +/- 13.9 years), who started antidepressant treatment from April 2006 through March 2007. Additionally, we evaluated Medication Possession Rate (MPR), defined as the total days a medication was dispensed to patients divided by the treatment period.


RESULTS
Only 161 patients (44.3%) continued antidepressant treatment for 6 months. Among 252 patients who discontinued their initial antidepressant, 63.1% of these patients did so without consulting their physicians. Sertraline use was associated with a higher persistence rate at month 6 (odds ratio 2.59 in comparison with sulpiride), and the use of anxiolytic benzodiazepines had a positive effect on persistence to antidepressant treatment only at month 1 (odds ratio 2.14). An overall MPR was 0.77; 55.6% of patients were considered compliant (i.e., a MPR of > or = 0.8).


CONCLUSIONS
Given a high rate of antidepressant discontinuation without consulting their physicians, closer communication between patients and their physicians should be encouraged. Although the use of anxiolytic benzodiazepines was associated with a higher persistence to antidepressant treatment at month 1, the use of these drugs should be avoided as a rule, given their well-known serious adverse effects.
Sawada
Norifusa
N
Department of Psychiatry, Saiseikai Central Hospital, Tokyo, Japan. sawada_@tb3.so-net.ne.jp
Uchida
Hiroyuki
H
Suzuki
Takefumi
T
Watanabe
Koichiro
K
Kikuchi
Toshiaki
T
Handa
Takashi
T
Kashima
Haruo
H
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010352:Patient Dropouts; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D020280:Sertraline / Q000627:therapeutic use; D016903:Drug Monitoring
D000928:Antidepressive Agents; D001569:Benzodiazepines; D020280:Sertraline