How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations

Abstract

Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).

Predictors of drug-drug interactions of medications prescribed to patients admitted due to suicidal behavior

“…Significantly, this emphasizes the necessity of greater attention to drug prescription safety provided after hospital discharge, as well as the necessity of providing psychoeducation and subsequent patient monitoring ( Riblet et al., 2017 ; Solmi et al., 2020 ; Yanagina et al., 2017 ; Zhao et al., 2015 ). Psychoeducation is an important strategy for providing patients with necessary information on safe drug use, and thus prevent suicide attempts and deaths ( Riblet et al., 2017 ; Solmi et al., 2020 ; Yanagida et al., 2017 ; Zhao et al., 2015 ).…”

“…Significantly, this emphasizes the necessity of greater attention to drug prescription safety provided after hospital discharge, as well as the necessity of providing psychoeducation and subsequent patient monitoring ( Riblet et al., 2017 ; Solmi et al., 2020 ; Yanagina et al., 2017 ; Zhao et al., 2015 ). Psychoeducation is an important strategy for providing patients with necessary information on safe drug use, and thus prevent suicide attempts and deaths ( Riblet et al., 2017 ; Solmi et al., 2020 ; Yanagida et al., 2017 ; Zhao et al., 2015 ). One of the key recommendations is adequate orientation of patients to ensure drug safety after hospital discharge, performed by the healthcare team during patient hospitalization (especially for those with potential drug interaction presence and previous suicide attempts), considering the high risks related to health problems.…”

“…In addition, drug-drug interactions are associated with increased hospital stay and costs ( Moura et al., 2009 ). The literature shows important strategies for drug interaction and harm prevention, such as Software use for automatic drug interactions check (i.e., the Micromedex used in present paper); implementing computer prescription systems with electronic drug interaction alerts ( Nuckols et al., 2014 ; Westbrook et al., 2013 ); multidisciplinary actuation (with an on-staff clinical pharmacist) ( Jankovic et al., 2018 ; Ribeiro et, al 2019 ; Yasu et al., 2018 ); psychoeducation ( Riblet et al., 2017 ; Solmi et al., 2020 ; Yanagida et al., 2017 ; Zhao et al., 2015 ); drug reconciliation ( Day et al., 2017 ); the caregivers’ involvement in patient treatment ( Fulmer, 2016 ); as well as improvements in the qualification of health professionals.…”

Addressing adherence to antidepressant treatment for depression

“…Another important point raised by Solmi et al 1 is that we continue to be hindered by our trial and error approach to depression treatment. We do a disservice to our patients by continuing to view depression as a behavioral disorder when the evidence indicates that it is a biological disorder of the brain, as well as that each individual has unique variations of genetics, brain structures, and other biological factors in addition to the psychosocial factors linked to depression.…”

“…So, why do people who display enough depressive symptoms to warrant psychopharmacological treatment stop taking their medication? Solmi et al 1 provide an excellent review of factors that may be the leading causes of non-adherence to antidepressants. The authors classify these factors as patient-related or provider-related.…”