Adherence to treatment in mood disorders

Nonadherence to medication is common in mood disorders. Improving adherence should decrease risk of relapse, improve outcome and lessen costs. Here we review recent qualitative and quantitative work in this area.

Themes that emerged from qualitative studies for nonadherence are discomfort about psychiatric diagnoses, including denial of the illness, problematic side effects, fears around dependency and the view that medication was unhelpful following resolution of the acute phase. The psycho-educational intervention model alone has shown little improvement in adherence. The collaborative managed care model for improving outcomes in depression in primary care is of limited benefit in increasing adherence or indeed outcomes. Psychological approaches have been most successful when concentrating on the patient-clinician alliance when attitudes and experience are explored, recognizing the importance of the patient's opinion in treatment decisions. Psycho-pharmaceutical interventions such as changing medication preparations have potential efficacy.

There are difficulties in assessing adherence and developing interventions. The majority of both qualitative and quantitative studies indicate that a collaborative approach when patients are involved in the decision-making process appear to be the most effective. The focus on trial driven, specialty-specific interventions may not be the most helpful way to investigate or improve adherence. This is a fertile area for qualitative work. Interventions that focus on the structure of care alongside increasing patient involvement in treatment have the most potential to improve adherence and hence outcome in mood disorders.