title: Motivational pharmacotherapy: combining motivational interviewing and antidepressant therapy to improve treatment adherence.
abstract: Treatment non-adherence in psycho-pharmacotherapy remains a significant challenge to the effective clinical management of psychiatric disorders, especially among underserved racial/ethnic groups. This article introduces motivational pharmacotherapy, an approach that integrates motivational interviewing into psycho-pharmacotherapy sessions in order to increase treatment adherence. We describe what aspects of motivational interviewing were incorporated into motivational pharmacotherapy and how we tailored the intervention to the clinical and cultural characteristics of monolingual Spanish-speaking immigrants with major depressive disorder. Transcriptions of the interactions between psychiatrists and patients help illustrate this approach. In our experience, motivational pharmacotherapy differs substantially from standard pharmacotherapy in how it recasts clinicians and patients as equal experts, prioritizes patients' motivation to engage in treatment rather than clinicians' multiple inquiries about symptoms, encourages patients' self-efficacy to overcome barriers, and attends to the momentum of patients' language about commitment to change. We also found that motivational pharmacotherapy can be feasibly incorporated into medication treatment, can be tailored to patients' culture and disorder, and may help increase adherence to psycho-pharmacotherapy.
authors: Department of Psychiatry at Columbia University, New York State Psychiatric Institute, USA.
authors: Iván C
authors: IC
authors: Balán
authors: Theresa B
authors: TB
authors: Moyers
authors: Roberto
authors: R
authors: Lewis-Fernández
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000208:ethnology / Q000628:therapy*; D054242:Emigrants and Immigrants / Q000523:psychology; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology*; D062405:Motivational Interviewing / Q000379:methods*; D010817:Physician-Patient Relations; D020377:Self Efficacy; D014481:United States
chemical_list: D000928:Antidepressive Agents
references: Lancet. 2003 Feb 22;361(9358):653-61
references: 12606176
references: Br J Gen Pract. 2005 Apr;55(513):305-12
references: 15826439
references: Med Care Res Rev. 2007 Aug;64(4):416-30
references: 17684110
references: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011
references: 18425859
references: Gen Hosp Psychiatry. 2006 Jan-Feb;28(1):27-36
references: 16377362
references: J Consult Clin Psychol. 2009 Dec;77(6):1113-24
references: 19968387
references: J Clin Psychiatry. 1997 May;58(5):196-204
references: 9184613
references: Med Care. 2006 May;44(5):398-405
references: 16641657
references: Am J Psychiatry. 2002 Oct;159(10):1653-64
references: 12359668
references: Med Care. 2008 Mar;46(3):247-56
references: 18388839
references: Acta Psychiatr Scand. 2002 Mar;105(3):164-72
references: 11939969
references: Am J Psychiatry. 2006 Nov;163(11):1905-17
references: 17074942
references: Community Ment Health J. 2010 Oct;46(5):466-73
references: 20556512
references: Clin Schizophr Relat Psychoses. 2010 Apr;4(1):74-91
references: 20643631
references: Annu Rev Clin Psychol. 2005;1:91-111
references: 17716083