Observational studies (Vergouwen et al) have reported alarmingly high discontinuation rates for patients taking antidepressant medication (28% at 1 month and 44-52% at 3 months).

One group of health professionals who can potentially have a major impact on this issue are pharmacists.

This new systematic review conducted by researchers from Riyadh in Saudi Arabia, set out to explore different types of pharmacist interventions used for enhancing patient adherence to antidepressant medications. They were specifically interested in 3 questions:

1. What is the impact of pharmacist interventions on adherence to antidepressant medication?
2. What is the impact of pharmacist interventions on patient-reported outcomes and patient satisfaction?
3. What are the types of interventions used by pharmacists to enhance patients’ adherence to antidepressants?

The authors searched a wide range of databases and limited their search to articles published since 2000. They found 12 studies to include in their analysis. The included studies were not perfect. Many had fairly short follow-up and overall the pharmacist-patient ratio was 1:14, which is clearly not comparable to most clinical practice. The nature of the intervention meant that it was not possible to blind the patients or the pharmacists from the treatment. Many of the studies did not report proper allocation concealment.

So the results should be interpreted with caution, but here’s what they found:

• Patient education and drug monitoring was the most common approach taken by pharmacists
• Combining a range of approaches, pharmacists managed to achieve a 15-27% improvement in patient adherence to antidepressants

The reviewers concluded:

This review suggests that pharmacist intervention is effective in the improvement of patient adherence to antidepressants. This may be a basis for more studies examining the effectiveness of innovative interventions by pharmacists to enhance patient adherence to antidepressant medications.

Links

Al-Jumah KA, Qureshi NA. Impact of pharmacist interventions on patients’ adherence to antidepressants and patient-reported outcomes: a systematic review. Patient Prefer Adherence. 2012;6:87-100. Epub 2012 Jan 31.

Vergouwen ACM, Bakker A, Katon WJ, Verheij TJM, Koerselman F. Improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry. 2003;64:1415–1420. [PubMed abstract]