Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trialBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7210.612 (Published 04 September 1999) Cite this as: BMJ 1999;319:612
- Robert Peveler, clinical reader in psychological medicine ()a,
- Charles George, professor of clinical pharmacologyb,
- Ann-Louise Kinmonth, professor of general practicec,
- Michael Campbell, professor of medical statisticsd,
- Chris Thompson, professor of psychiatrya
- 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
- Accepted 20 May 1999
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.
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
Funding Medical Research Council (grant G9322875). Dothiepin for electromechanically monitored patients was donated by Knoll pharmaceuticals.
Competing interests None declared.
- Accepted 20 May 1999