Adherence Should be Monitored Before Increasing Doses

A new study calls for greater collaboration between pharmacists and physicians to optimize the benefits of antidepressants.

When patients don’t respond to antidepressants, a number of questions arise. In their rush to find answers, prescribers may overlook a fundamental question that could make or break clinical outcomes: is the patient actually taking the medication as directed?

For 1 in 3 patients whose physicians prescribe higher doses of antidepressants, the answer is no. This is the conclusion researchers at the Medco Research Institute drew from a new adherence study, which was presented at the American Psychiatric Association’s 62nd Institute on Psychiatric Services in Boston.

Their results suggest more consideration should be given to adherence when devising solutions to poor or partial medication response in patients with depression. They also add to the mounting evidence that pharmacists and physicians working in tandem can optimize drug therapy regimens.

“A physician usually increases a dose when a patient is not responding to the current dosage,” said David J. Muzina, MD, the study’s lead author. “This analysis shows that the reason the dose may not be effective is that many patients are not taking their antidepressants as directed.”

In the study of medical and pharmacy claims records for 13 million individuals, 29.7% of patients whose dosages were increased after a relapse of depression had adherence rates of 80% or lower in the previous 6 months. Researchers determined adherence by looking at how often patients had their prescriptions refilled.

When adherence is a problem, “upping the dose may not remedy that issue,” Dr. Muzina said. Increased doses can lead not only to unnecessary costs, but also a greater risk of adverse events. The study points to a better remedy, revealed in refill rates for a specific subset of patients—those who received regular counseling from Medco’s specialist pharmacists.

Among these patients, adherence rates were “significantly higher,” the researchers noted. Special attention from pharmacists could provide just the support patients need to succeed with treatment, according to Dr. Muzina. “It’s important that these adherence problems be identified and addressed to enable patients with depression to fully benefit from their medications,” he concluded.