BMJ 1999;319:612-615 ( 4 September )

General Practice

Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial

Robert Peveler, clinical reader in psychological medicine, a Charles George, professor of clinical pharmacology, b Ann-Louise Kinmonth, professor of general practice, c Michael Campbell, professor of medical statistics, d Chris Thompson, professor of psychiatry. a

a Mental Health Group, University of Southampton, Royal South Hants Hospital, Southampton SO14 0YG, b Clinical Pharmacology Group, Biomedical Sciences Building, Southampton SO16 7PX, c General Practice and Primary Care Unit, Institute of Public Health Medicine, University of Cambridge, Cambridge CB2 2SR, d School of Health and Related Research, University of Sheffield, Northern General Hospital, Sheffield S5 7AU

Correspondence to: R Peveler rcp{at}soton.ac.uk

Objectives: To evaluate two different methods of improving adherence to antidepressant drugs.
Design: Factorial randomised controlled single blind trial of treatment leaflet, drug counselling, both, or treatment as usual.
Setting: Primary care in Wessex
Participants: 250 patients starting treatment with tricyclic antidepressants.
Main outcome measures: Adherence to drug treatment (by confidential self report and electronic monitor); depressive symptoms and health status.
Results: 66 (63%) patients continued with drugs to 12 weeks in the counselled group compared with 42 (39%) of those who did not receiving counselling (odds ratio 2.7, 95% confidence interval 1.6 to 4.8; number needed to treat=4). Treatment leaflets had no significant effect on adherence. No differences in depressive symptoms were found between treatment groups overall, although a significant improvement was found in patients with major depressive disorder receiving drug doses of at least 75 mg (depression score 4 (SD 3.7) counselling v 5.9 (SD 5.0) no counselling, P=0.038).
Conclusions: Counselling about drug treatment significantly improved adherence, but clinical benefit was seen only in patients with major depressive disorder receiving doses >= 75 mg. Further research is required to evaluate the effect of this approach in combination with appropriate targeting of treatment and advice about dosage.


Key messages

  • Non-adherence is a serious problem in the treatment of depression by general practitioners

  • In this study a brief psychosocial intervention delivered by a nurse greatly improved adherence

  • Clinical benefit was apparent only in patients with major depressive episodes on higher doses of drugs

  • Counselling should be targeted at patients with symptoms of at least moderate severity and combined with therapeutic drug doses




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