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ADHERENCE CHALLENGES

Adherence is the extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider (WHO, 2003).

Within every person is a spontaneous need for happiness, understanding, and love, yet neither psychiatry nor psychology has been effective in understanding the steps that lead to a happy life.

  • ROGER KATHOL, MD

Adherence challenges are numerous in the management of depression. In all serious mental illnesses, medication non-adherence has been shown to be one of the strongest predictors of hospital readmission.57 Individuals with mental illness typically have great difficulty following a medication regimen, but they also have the greatest potential for benefiting from adherence.62 In a recent review of 14 epidemiologic studies, reported rates of adherence to medical treatments for unipolar depression varied from 30% to 97% (Figure 4).62 Another review found that up to 70% of individuals with depression are non- adherent either as the result of missed doses or premature discontinuation.59 Half of patients with major depression for whom antidepressants are prescribed will not be taking the drugs three months after the initiation of therapy.60 Among those with Bipolar Affective Disorder the rates of adherence are as low as 36%.61

Figure 4 Adherence to Antidepressant Therapy62

100

Compliance, %

80

60

40

20

0

27

29

46

100

112

125

164 210 238

468

874 1242 2432 4052

Sample Size

Depression

Notes

27

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