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

Solmi, Marco and Miola, Alessandro and Croatto, Giovanni and Pigato, Giorgio and Favaro, Angela and Fornaro, Michele and Berk, Michael and Smith, Lee and Quevedo, Joao and Maes, Michael and Correll, Christoph and Carvalho, Andre F. (2021) How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. Brazilian Journal of Psychiatry, 43 (2). pp. 189-202. ISSN 1809-452X

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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).

Item Type: Journal Article
Keywords: adherence, compliance, antidepressant, therapeutic drug monitoring, psychiatry, depression, mood disorders, treatment
Faculty: Faculty of Science & Engineering
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 06 Apr 2020 11:05
Last Modified: 09 Sep 2021 18:51

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