Faculty of Pharmacy, The University of Sydney, NSW, Australia.
Int J Clin Pract. 2011 Sep;65(9):954-75. doi: 10.1111/j.1742-1241.2011.02746.x.
Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression in clinical practice. This review aims to systematically assess the effectiveness of interventions for improving antidepressant medication adherence among patients with unipolar depression, and to evaluate the effect of these interventions on depression clinical outcomes. MEDLINE, PsycINFO and EMBASE databases were searched for English-language randomised controlled trials published between January 1990 and December 2010 on interventions to improve antidepressant adherence. The impact of interventions on antidepressant medication adherence (compliance and persistence) and depression clinical outcomes was evaluated. Data concerning the quality of the included studies were also extracted. Twenty-six studies met the inclusion criteria. Interventions were classified as educational, behavioural and multifaceted interventions. A total of 28 interventions were tested, as two studies investigated two interventions each. Sixteen (57%) of the 28 interventions showed significant effects on antidepressant adherence outcomes, whereas 12 (43%) interventions demonstrated significant effects on both antidepressant adherence and depression outcomes. The interventions which showed significant improvement in outcomes were primarily multifaceted and complex, with proactive care management and involvement of mental health specialists. The most commonly used elements of multifaceted interventions included patient educational strategies, telephone follow-up to monitor patients' progress, as well as providing medication support and feedback to primary care providers. Overall, educational interventions alone were ineffective in improving antidepressant medication adherence. In conclusion, improving adherence to antidepressants requires a complex behavioural change and there is some evidence to support behavioural and multifaceted interventions as the most effective in improving antidepressant medication adherence and depression outcomes. More carefully designed and well-conducted studies are needed to clarify the effect of interventions in different patient populations and treatment settings.
抗抑郁药物治疗不依从是临床实践中成功治疗抑郁症的一个重大障碍。本综述旨在系统评估改善单相抑郁患者抗抑郁药物治疗依从性的干预措施的有效性，并评估这些干预措施对抑郁临床结局的影响。检索了 MEDLINE、PsycINFO 和 EMBASE 数据库，以获取 1990 年 1 月至 2010 年 12 月期间发表的关于改善抗抑郁药物依从性的干预措施的英文随机对照试验。评估了干预措施对改善抗抑郁药物治疗依从性（遵医嘱和持续用药）和抑郁临床结局的影响。还提取了有关纳入研究质量的数据。26 项研究符合纳入标准。干预措施分为教育、行为和多方面干预措施。共测试了 28 种干预措施，因为有两项研究分别研究了两种干预措施。28 种干预措施中的 16 种（57%）对抗抑郁药物治疗依从性结局有显著影响，而 12 种（43%）干预措施对抗抑郁药物治疗依从性和抑郁结局都有显著影响。在结局方面显示出显著改善的干预措施主要是多方面和复杂的，采用主动护理管理并纳入精神卫生专家。多方面干预措施中最常用的元素包括患者教育策略、电话随访以监测患者进展，以及为初级保健提供者提供药物支持和反馈。总的来说，单独的教育干预措施不能有效提高抗抑郁药物的治疗依从性。结论：提高抗抑郁药物的依从性需要进行复杂的行为改变，有证据支持行为和多方面的干预措施是改善抗抑郁药物治疗依从性和抑郁结局最有效的方法。需要进行更精心设计和良好实施的研究，以阐明不同患者人群和治疗环境中干预措施的效果。
