Vergouwen Anton C M, Bakker Abraham, Katon Wayne J, Verheij Theo J, Koerselman Frank
Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
J Clin Psychiatry. 2003 Dec;64(12):1415-20. doi: 10.4088/jcp.v64n1203.
Effectiveness of antidepressant medication is reduced by patients' nonadherence. Several interventions to improve adherence in patients diagnosed with unipolar depression have been tested.
To systematically review the effectiveness of interventions that aimed to improve adherence to antidepressant medication in patients with unipolar depression.
Systematic review of English-language articles of randomized controlled trials obtained by a computerized literature search of MEDLINE (1966-January 2002) using the terms patient compliance, patient dropout, treatment refusal, patient education, adherence, clinical trial, randomized controlled trial, controlled trial, depressive disorder, and depression; PSYCINFO (1984-January 2002) using the terms random, clinical, control, trial, adherence, compliance, noncompliance, dropouts, patient education, depression, major depression, affective disorders, and dysthymic disorder; EMBASE (1980-January 2002) using the terms patient compliance, patient dropouts, illness behavior, treatment refusal, patient education, clinical trial, controlled study, randomized controlled trial, and depression; and the Cochrane Controlled Trials Register (no restrictions) using the terms random*, complian*, adheren*, pharmacotherapy, regimen*, educat*, medicat*, depression, and depressive disorder.
Educational interventions to enhance adherence failed to demonstrate a clear benefit on adherence and depression outcome. However, collaborative care interventions tested in primary care demonstrated significant improvements in adherence during the acute and continuation phase of treatment and were associated with clinical benefit, especially in patients suffering from major depression who were prescribed adequate dosages of antidepressant medication.
We found evidence to support the introduction of interventions to enhance adherence with antidepressant medication in primary care, not only because of better adherence but also because of better treatment results. Because collaborative care interventions require additional resources, a better understanding of the mode of action of different programs is needed to reduce avoidable costs. The effectiveness of educational interventions needs more evidence.
患者不依从会降低抗抑郁药物的疗效。已经对几种旨在提高单相抑郁症患者依从性的干预措施进行了测试。
系统评价旨在提高单相抑郁症患者抗抑郁药物依从性的干预措施的有效性。
通过使用患者依从性、患者退出、治疗拒绝、患者教育、依从性、临床试验、随机对照试验、对照试验、抑郁症和抑郁等术语，对MEDLINE（1966年 - 2002年1月）进行计算机文献检索，系统评价英文随机对照试验文章；使用随机、临床、对照、试验、依从性、依从、不依从、退出、患者教育、抑郁症、重度抑郁症、情感障碍和心境恶劣障碍等术语，对PSYCINFO（1984年 - 2002年1月）进行检索；使用患者依从性、患者退出、疾病行为、治疗拒绝、患者教育、临床试验、对照研究、随机对照试验和抑郁症等术语，对EMBASE（1980年 - 2002年1月）进行检索；并使用随机*、依从*、依从*、药物治疗、治疗方案*、教育*、药物*、抑郁症和抑郁障碍等术语，对Cochrane对照试验注册库（无限制）进行检索。
旨在提高依从性的教育干预措施未能在依从性和抑郁结局方面显示出明显益处。然而，在初级保健中测试的协作护理干预措施在治疗的急性期和延续期显示出依从性有显著改善，并具有临床益处，特别是在接受足够剂量抗抑郁药物治疗的重度抑郁症患者中。
我们发现有证据支持在初级保健中引入提高抗抑郁药物依从性的干预措施，不仅因为依从性更好，而且因为治疗效果更好。由于协作护理干预措施需要额外资源，因此需要更好地了解不同方案的作用模式以降低可避免的成本。教育干预措施的有效性需要更多证据。
