Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis

Abstract

Background Non-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase. Methods We searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted. Results Forty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54). Conclusions Our findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts. Trial registration International Prospective Register for Systematic Reviews (PROSPERO) number: CRD42017065723.

Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial

“…A series of 4-h group sessions consisting of two interactive online sessions, one month apart, led by a clinical leader along with the principal investigator were set up. The contents and procedures of the sessions were designed based on the results of the literature review carried out in a previous study ( 24 ), selecting the best documented and evaluated interventions providing valid data on the results of adherence to pharmacological treatment and over the long term.…”

“…To address adherence issues effectively, multiple approaches consider these factors with the aim of improving medication adherence and treatment outcomes. A recently published systematic review has shown that multicomponent interventions improve short and medium-term adherence to medication among adults with depressive disorders, but there is insufficient evidence in the literature to draw longer-term conclusions ( 24 ). However, the evidence strongly supports the effectiveness of collaborative care in improving adherence among adults with depressive disorders ( 24 ).…”

“…A recently published systematic review has shown that multicomponent interventions improve short and medium-term adherence to medication among adults with depressive disorders, but there is insufficient evidence in the literature to draw longer-term conclusions ( 24 ). However, the evidence strongly supports the effectiveness of collaborative care in improving adherence among adults with depressive disorders ( 24 ). These results corroborated the notion that collaborative care has the potential to be not only clinically beneficial for addressing symptom management in adults with depressive disorders ( 25 , 26 ), but also to significantly enhance treatment adherence.…”

Efficacy and tolerability of minocycline in depressive patients with or without treatment-resistant: a meta-analysis of randomized controlled trials

“…Notably, the World Health Organization has recognized it to be the leading cause of disability worldwide ( 1 ). Major depressive disorder (MDD) is a form of severe mental dysfunction that affects approximately 6% of adults worldwide and is associated with significant mortality, morbidity, and social costs ( 2 ). Several measures, including psychotherapy, physical therapy, and pharmacotherapy, have been adopted for treating MDD.…”

Protocol for the systematic review and meta-analysis of factors associated with non-adherence to antidepressants in depressive disorders in those more than 18 years of age

“…A review by Chong and colleagues on interventions aimed at improving adherence to antidepressants reported that multifaceted interventions involving both service user and provider with behavioral component were effective [ 1 ], which was supported by another targeted review [ 13 ]. However, a meta-analysis published recently concluded that the interventions are effective only in the first six months [ 14 ].…”