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“The program helps patients address barriers [such as stigma, misconceptions, and fears], identify treatment benefits, and feel empowered to manage their medication regimen and communicate with the physician effectively,” wrote Jo Anne Sirey, Ph.D., a professor of clinical psychology in psychiatry at Weill Cornell Medical College, and colleagues.
A total of 231 adults aged 55 and older who had been recently prescribed an antidepressant by their primary care physician for depression were randomly assigned to receive either the Treatment Initiation and Participation (TIP) intervention and antidepressant monitoring by their primary care physician or only treatment monitoring by their primary care physician.
Patients in the TIP group met with social workers for three, 30-minute meetings over the first six weeks of antidepressant treatment. The intervention included five steps: 1) review symptoms and antidepressant regimen and conduct a barriers assessment; 2) define a personal goal that could be achieved with adherence; 3) provide education about depression and antidepressant therapy; 4) collaborate to address barriers to treatment participation; and 5) create an adherence strategy and empower the older adult to talk directly with the primary care physician about treatment.
At the start of the study and at weeks 6, 12, and 24, the researchers used the Brief Medication Questionnaire and the 24-item Hamilton Depression Rating Scale (HAM-D) to assess antidepressant adherence and depression symptoms. Adequate early adherence was defined as taking 80% or more of the prescribed doses at 6 and 12 weeks.
Sirey and colleagues found that throughout the study period, rates of adherence were higher among participants in the TIP group; these patients were five times more likely to adhere to their antidepressant at week 6, and nearly three times more likely to be adherent at both 6 and 12 weeks. Although TIP was not associated with overall improvement of depression, patients in the TIP group showed a significant earlier reduction in depressive symptoms at six weeks, the authors noted.
“Given the high rates of depression, nonadherence, and use of primary care as a mental health service, wide-scale implementation of a targeting adherence intervention such as TIP could have a meaningful impact on public health,” Sirey and colleagues concluded. “Improved adherence can promote improvement in depression.”
For related information, see the Psychiatric News article “Low-Cost Reminders Fail to Improve Medication Adherence.”
(Image: iStock/sturti)