title: Antidepressant nonadherence in routine clinical settings determined from discarded blood samples.
abstract: OBJECTIVE
  Antidepressant nonadherence is common and represents a potentially modifiable risk factor for treatment nonresponse. We used a novel approach based on discarded blood samples from routine clinical blood draws to assess treatment nonadherence in a general clinical population.
  
  
  METHODS
  Individuals diagnosed with or without major depressive disorder (using ICD-9) and prescribed sertraline, citalopram, bupropion, or venlafaxine in January 2014 were identified by querying the electronic health record of 2 academic medical centers. Discarded blood samples from routine blood draws for 109 individuals within 14-90 days of treatment initiation were anonymized and then assessed for detectable serum antidepressant levels.
  
  
  RESULTS
  Overall, 17% of samples lacked detectable levels of the index antidepressant. Individuals with public versus private insurance were more likely to have undetectable antidepressant levels (χ(2)1 = 5.07, P = .02) as were those receiving shorter-term (< 90 days) prescriptions (χ(2)1 = 4.03, P = .05).
  
  
  CONCLUSIONS
  In general, electronic prescribing data provided a reasonable proxy for actual antidepressant use. Additionally, up to 1 in 5 individuals prescribed an antidepressant may not be adherent, suggesting the need for further efforts to reduce treatment nonadherence.
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Ashlee M
authors.initials: AM
authors.lastname: Roberson
authors.forename: Victor M
authors.initials: VM
authors.lastname: Castro
authors.forename: Andrew
authors.initials: A
authors.lastname: Cagan
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
mesh_terms: D000928:Antidepressive Agents / Q000097:blood* / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000097:blood* / Q000188:drug therapy; D055695:Electronic Prescribing / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents