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Major depression and medication adherence in elderly patients with coronary artery disease
R M Carney1, K E Freedland, S A Eisen
1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 633110, USA.
Insights
Major depression significantly impacts medication adherence in older adults with coronary artery disease. Depressed patients were less likely to follow their prescribed aspirin regimen, highlighting a critical area for intervention.
Area of Science:
- Geriatric Medicine
- Cardiology
- Psychiatry
Background:
- Depression's impact on medical treatment adherence in elderly patients with chronic conditions is understudied.
- Poor adherence may contribute to increased medical risks in depressed patients.
Purpose of the Study:
- To investigate the relationship between major depression and adherence to medical treatment in older adults with coronary artery disease.
Main Methods:
- Fifty-five patients over 64 with coronary artery disease were assessed for major depression.
- Medication adherence to a twice-daily low-dose aspirin regimen was monitored electronically for 3 weeks.
Main Results:
- Ten patients met criteria for major depression.
- Depressed patients adhered to the aspirin regimen on 45% of days, compared to 69% for non-depressed patients (p < .02).
Conclusions:
- Major depression is associated with significantly poorer adherence to prophylactic aspirin therapy in elderly patients diagnosed with coronary artery disease.
Abstract:
Little is known about the effects of depression on adherence to medical treatment regimens in older patients with chronic medical illnesses. Poor adherence may explain the increased risk of medical morbidity and mortality found in depressed medical patients. Ten of 55 patients over the age of 64 with coronary artery disease met the criteria for major depression from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987). All patients were prescribed a twice-per-day regimen of low dose aspirin to reduce their risk for myocardial infarction. Medication adherence was assessed for 3 weeks by an unobtrusive electronic monitoring device. Depressed patients adhered to the regimen on 45% of days, but nondepressed patients, on 69% (p < .02). Thus, major depression is associated with poor adherence to a regimen of prophylactic aspirin after the diagnosis of coronary artery disease.