Implementation of a psychosocial intervention program that encouraged identification of barriers to adherence before creating a personal adherence strategy was shown to improve adherence to pharmacotherapy in older adults initiated on antidepressants, according to the results of a study published in JAMA Psychiatry.
In this randomized controlled trial (clinicaltrials.gov identifier: NCT01301859), researchers enrolled patients ≥55 years (mean age 67.3 years) who were being initiated on depression pharmacotherapy by their primary care physicians. Participants were either enrolled in the Treatment and Participation Program (n=115) or given treatment as usual (n=116). The Treatment and Participation Program involved a review of symptoms, antidepressant regimen, and barriers assessment; definition of a personal goal that could be achieved with adherence; education about depression and therapy; collaboration to address barriers; and creation of an adherence strategy.
After 6 weeks of treatment, participants in the intervention group were significantly more likely to be adherent than those not participating in the program (odds ratio 5.54; 95% CI, 2.57-11.96; P <.001). Moreover, participants in the Treatment and Participation Program had a significant reduction in depressive symptoms at 6 weeks (24.9%; P <.001), whereas those in the control group had a nonsignificant improvement (10.7%; adjusted P =.05).
Adherence of 80% at weeks 6 and 12 was associated with a 15% improvement in depressive symptoms in both groups (95% CI, -0.2 to -30; t369=1.93; P =.051).
In an interview with Psychiatry Advisor, Jo Anne Sirey, PhD, Professor of Psychology in Psychiatry at Weill Cornell Institute of Geriatric Psychiatry and lead author on the study, explained that “adherence is a significant and modifiable barrier to quality care for depression.” She noted, however, that “it is necessary to be adherent to improve depression, but not sufficient,” highlighting that other factors such as treatment adequacy also play a role.
Sirey JA, Banerjee S, Marino P, et al. Adherence to depression treatment in primary care: a randomized clinical trial [published online September 27, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.3047