Adherence to Antidepressant Combinations and Monotherapy for Major Depressive Disorder

Warden, Diane; Trivedi, Madhukar H.; Carmody, Thomas; Toups, Marisa; Zisook, Sidney; Lesser, Ira M.; Myers, Alyson; Kurian, Kolette Ring Benji; Morris, David W.; Rush, A. John

doi:10.1097/01.pra.0000445246.46424.fe

Cited by 27 publications

(28 citation statements)

References 49 publications

(67 reference statements)

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“…Also in the present study, the dichotomous (PDC ≥80% cut‐off) antidepressant adherence was 25.7%, which is also in the range of previous studies . Thus, adherence to ACs and antidepressants were suboptimal . The low adherence in both asthma and depression may be influenced by medication side effects, lack of patient education on disease management, or lack of motivation.…”

Section: Discussionsupporting

confidence: 63%

“…Higher asthma‐related prescription cost was offset by lower asthma‐related outpatient costs in asthma patients with comorbid depression compared to those with asthma alone. While no similar studies were conducted examining the impact of comorbid depression on total asthma‐related healthcare costs, several studies demonstrated that asthma patients with comorbid depression have higher asthma‐related prescription costs and lower asthma‐related inpatient visit(s) costs compared to those with asthma alone . This study's findings suggest that asthma patients with comorbid depression should be managed for both conditions, not just their asthma alone.…”

Section: Discussionmentioning

confidence: 73%

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Impact of comorbid depression on medication adherence and asthma-related healthcare costs in Texas Medicaid patients with asthma

Gupte-Singh

Kim

Barner

2015

Journal of Pharmaceutical Health Services Research

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Objectives To compare: (1) rates of adherence to asthma controllers (ACs) between patients with asthma alone (A) and patients with asthma and comorbid depression (A + D);(2) rates of adherence to AC between patients who adhere to antidepressants and patients who do not adhere to antidepressants; and (3) asthma-related healthcare costs between the A and A + D groups. Methods Texas Medicaid insurance claims from 1 January 2007 to 31 October 2011 were extracted for adults (18-63 years) diagnosed with asthma with at least two fills of the same AC (inhaled corticosteroids, long-acting beta agonists, fixed-dose combinations (FDC) and leukotriene modifiers) in the A group, and at least two antidepressant claims in the A + D group. Proportion of days covered (PDC) was used to assess adherence to antidepressants and AC, while controlling for demographics, chronic disease score (CDS) and AC therapy type (monotherapy, FDC, dual therapy). Asthma-related healthcare costs included asthma-related prescriptions, inpatient and outpatient costs. Descriptive statistics, Wilcoxon test and regression analyses were used. Key findings The patients (n = 3626) were 40.1 AE 14.0 years, primarily women (75.0%), Caucasians (37.3%), FDC therapy users (56.3%), with CDS = 0 (74.2%). Results showed that compared to the A group (n = 3400), patients in the A + D group (n = 226) were 1.6 times more likely to adhere (PDC ≥50%) to their AC (odds ratio (OR) = 1.596; 95% confidence interval (CI) = 1.198-2.128; P < 0.001). Compared to patients who do not adhere to antidepressants (PDC <80%) (n = 140), patients who adhered to antidepressants (PDC ≥80%) (n = 86) were 2.5 times more likely to adhere (PDC ≥50%) to AC, while controlling for covariates (OR = 2.517; 95% CI = 1.304-4.855; P = 0.006). After controlling for covariates, compared to the A group, the A + D disorder group had significantly lower total asthma-related healthcare costs (P < 0.001). Conclusions In the A + D group, the higher costs of asthma-related prescriptions was offset by the lower costs of inpatient and outpatient claims. Patients in the A + D group should be encouraged to adhere to both their ACs and antidepressants.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 73%

Impact of comorbid depression on medication adherence and asthma-related healthcare costs in Texas Medicaid patients with asthma

Gupte-Singh

Kim

Barner

2015

Journal of Pharmaceutical Health Services Research

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“…Group (Warden et al, 2014) × time point (3; baseline, week 4, week 8) ANOVAs examining changes in depression severity for both the HAM-D and PHQ-9 revealed a positive improvement in depressive symptoms across time ( F ≥ 19.1, P ≤ .0001 in each case), with the absence of a group × time interaction suggesting a comparable improvement across groups over the 8-week period ( F ≤ 2.14, P ≥ .15 in each case, see Fig. 2).…”

Section: | Resultsmentioning

confidence: 99%

“…Underlying causes for this public health problem are the modest effects of existing treatments, their limited accessibility and quality when delivered in routine practice, and the high rate of early treatment discontinuation for both psychotherapies and medications (Mulder, Frampton, Luty, & Joyce, 2009; Thase et al, 1992; Warden et al, 2014). According to the National Institute of Mental Health (NIMH), this problem is due to the fact that existing treatments only manage symptoms rather than treat to the underlying causes of depression (Insel & Wang, 2009).…”

Section: | Introductionmentioning

confidence: 99%

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial

2017

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Background Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol. Methods In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard. Results EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence. Conclusions This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings.

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“…In considering scaling-up the MBC intervention to all CNICS sites, treatment-variation irrelevance seems reasonable, given that MBC is a well-defined intervention that has been implemented in multiple settings. 39-41 However, these results are based on an implicit assumption that MBC could be implemented in the target population with the same fidelity as it was in SLAM DUNC.…”

Section: Discussionmentioning

confidence: 99%

Improving Depression Among HIV-Infected Adults: Transporting the Effect of a Depression Treatment Intervention to Routine Care

Bengtson¹,

Pence²,

Quinlivan

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Depression affects 20-30% of people with HIV. Randomized controlled trials (RCTs) have demonstrated the effectiveness of interventions to improve depression among HIV-infected adults, but typically have highly selected populations which may limit generalizability. Inverse probability of sampling weights (IPSW) are a recently proposed method to transport (or standardize) findings from RCTs to a specific external target population. Methods We used IPSW to transport the 6-month effect of the Measurement-Based Care (MBC) intervention on depression from the SLAM DUNC trial to a population of HIV-infected depressed adults in routine care in the United States between 2010 and 2014. Results In the RCT, MBC was associated with an improvement in depression at 6 months of 3.6 points on the Hamilton Depression Rating scale (95% CI: -5.9, -1.3). When IPSW were used to standardize results from the trial to the target population, the intervention effect was attenuated by 1.2 points (mean improvement 2.4 points; 95% CI: -6.1, 1.3). Conclusions If implemented among HIV-infected depressed adults in routine care, MBC may be less effective than in the RCT but can still be expected to reduce depression. Attenuation of the intervention effect among adults in routine care reflects the fact that the trial enrolled a larger proportion of individuals for whom the intervention was more effective. Given the burden of depression among HIV-infected adults, more effective interventions to improve depression are urgently needed. However, examining the transportability of trial findings is essential to understand whether similar effects can be expected if interventions are scaled-up.

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Adherence to Antidepressant Combinations and Monotherapy for Major Depressive Disorder

Abstract: With closely monitored treatment, non-adherence is low and unrelated to depressive symptom outcome. Nonadherence is highest with antidepressant combinations. Specific non-adherent events are most often sporadic.

Cited by 27 publications

References 49 publications

Impact of comorbid depression on medication adherence and asthma-related healthcare costs in Texas Medicaid patients with asthma

Impact of comorbid depression on medication adherence and asthma-related healthcare costs in Texas Medicaid patients with asthma

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial

Improving Depression Among HIV-Infected Adults: Transporting the Effect of a Depression Treatment Intervention to Routine Care

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