Frank E, Perel JM, Mallinger AG, Thase ME, Kupfer DJ. 1992 Relationship of pharmacologic compliance to long-term prophylaxis in recurrent depression

Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213.
Psychopharmacology bulletin (Impact Factor: 0.5). 02/1992; 28(3):231-5.
Source: PubMed


This report examines the relationship of long-term medication compliance (as measured by stability of level/dose ratios and total blood level averages) to prophylaxis in recurrent unipolar patients. Of the 53 patients assigned to active imipramine conditions in a long-term maintenance treatment protocol, 42 were evaluated as clearly compliant, 8 were clearly noncompliant, and 3 were not classifiable. We examined a number of demographic and clinical variables in an attempt to find possible predictors of compliance. No differences were observed between compliant and noncompliant patients with respect to sex, age at screening, age at the onset of their recurrent unipolar illness, duration of the index episode, number of previous episodes, bipolar II vs. recurrent unipolar subtype, endogenous vs. nonendogenous subtype, or baseline severity of depression as assessed by the Hamilton Rating Scale for Depression. However, medication compliance was found to be significantly associated with effective prophylaxis. There was a significantly larger proportion (6 of 12) of noncompliant patients among those experiencing a recurrence in one of the two active medication conditions than among those who remained well for 3 years (2 of 28). The value associated with this difference was p = .04. We conclude that effective prophylaxis is strongly related to stability of medication blood levels which fall within the therapeutic range.

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    • "Sedation may cause non-adherence as it damages functionality of the areas that one should make use of (Cobanoglu et al., 2003; Meric, 2006; Satatovic et al., 2007a, 2007b). Some studies show other reasons for patients' quitting pharmacological treatment as prejudices, unrealistic fears and ignorance rather than side effects (Colom et al., 2000; Frank et al., 1992). This indicates that pharmacological treatment should be supported with psychoeducation. "
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    ABSTRACT: This study examined the effectiveness of a six week psychoeducation program on the adherence of patients with Bipolar Affective Disorder. An experimental study was conducted at a mood disorder outpatient clinic in Zonguldak, Turkiye. Participants were randomly assigned to either intervention (n=35) or control groups (n=36). Both groups were given pre-tests and post-tests to measure their adherence. In the psychoeducation group, the psychoeducation program was provided for 2 h/week for six weeks. In the control group, standard care and information were provided. After six weeks, the psychoeducation program significantly improved patients' adherence. The treatment adherence rate of the patients in the intervention group increased from 40.0% (14 patients on pre-test), to 86.7% (26 patients on post-test). Meanwhile, the treatment adherence rate of the control group was 38.9% (14 patients) for the pre-test, and 24.2% (8 patients) for the post-test. This controlled trial study demonstrated that a six-week psychoeducation program can be a useful intervention to improve adherence in patients undergoing bipolar affective disorder rehabilitation. More comprehensive mental health outcomes need to be undertaken. Further studies exploring a longer term follow-up are also required.
    Full-text · Article · Feb 2012 · Journal of Affective Disorders
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    • "The results of earlier studies, where age was included as a potential predictor of adherence/nonadherence to antidepressants, are somewhat conflicting. In several studies, no relation between age and adherence was found (Frank et al 1992; Lin et al 1995; Bull et al 2002). However, in line with our fi nding, Demyttenaere and colleagues (1998) reported that young age was a predictor of premature dropout from antidepressant drug treatment. "
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    ABSTRACT: Poor adherence to antidepressant treatment is common, and results in increased disability and costs. Several factors are thought to influence patients' ability and willingness to adhere. So far, however, consensus is lacking regarding patient characteristics that predict nonadherence. The purpose of this study was to identify predictors of nonadherence to antidepressant treatment that can be ascertained at treatment start. The present study used data from a randomized controlled trial with the main objective of studying the effect of two different compliance-enhancing programs on treatment adherence and treatment response in 1031 primary care patients with major depression. In this study, logistic regression analyses were performed to examine patient- and illness-related characteristics potentially associated with nonadherence. Nonadherence to antidepressant treatment was predicted by age under 35 or over 64 years, presence of personality disorder, sensation-seeking personality traits, substance abuse, and absence of concomitant medications. Certain patient- and illness-related characteristics may imply an increased risk of nonadherence to antidepressant treatment. Giving special attention to subjects with such characteristics may improve adherence.
    Full-text · Article · Feb 2008 · Patient Preference and Adherence
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    • "They also conclude that one problem in the field is the unresolved debate concerning accurate terminology. In line with Frank et al. (1992), they advocate the term adherence instead of compliance because it puts greater emphasis on the role of the clinician in forming the therapeutic alliance and on the active, rather than passive, participation of the patient in this process. "
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    ABSTRACT: Medication non-adherence is a major obstacle in the treatment of affective disorders. The primary objective of this study was to evaluate two different interventions to improve adherence to antidepressant drugs. Secondary objectives included response to treatment, relation between adherence and response, patient satisfaction and tolerability. A randomized controlled design was used to assess the effect of a patient educational compliance enhancing programme (CP) and therapeutic drug monitoring in 1031 major depressed patients treated with sertraline for 24 weeks and managed by their general practitioner. Adherence was measured by questioning, measurable serum levels of sertraline and desmethylsertraline, appointments kept and a composite index including all three methods. Treatment adherence was found in 37-70% of patients, depending on the method used. Neither of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the CP group had responded at week 24 compared to patients in the control group. Overall, significantly more adherent patients responded to treatment compared to non-adherent patients, regardless of method used to determine adherence. This large study demonstrates that treatment response increases when using an educational compliance programme and that a strong relationship between treatment adherence and response exists.
    Full-text · Article · Nov 2003 · International Clinical Psychopharmacology
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