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THE ASSOCIATION BETWEEN ANTIDEPRESSANT DOSAGE TITRATION AND MEDICATION ADHERENCE AMONG PATIENTS WITH DEPRESSION
Author(s) -
Wu ChungHsuen,
Farley Joel F.,
Gaynes Bradley N.
Publication year - 2012
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.21952
Subject(s) - antidepressant , medicine , bupropion , hazard ratio , odds ratio , reuptake inhibitor , depression (economics) , major depressive disorder , confidence interval , psychiatry , pathology , amygdala , smoking cessation , economics , macroeconomics , hippocampus
Background To evaluate the association between upward dose titration of antidepressants and medication adherence during the first 6 months of a newly initiated antidepressant treatment for patients with major depressive disorder ( MDD ). Methods We conducted a retrospective observational cohort study using T homson R euters M arket S can C ommercial C laims and E ncounters C laims data. We identified 40,873 patients aged 18–64 with MDD newly initiating a selective serotonin reuptake inhibitor, serotonin‐norepinephrine reuptake inhibitor, or bupropion between J uly 1, 2005 and J une 30, 2007. Patients with titration (defined as antidepressant initiation at doses equal or lesser than American Psychiatric Association treatment guidelines with a dosage increase in the first 60 days of treatment) were compared to patients with no titration. Adherence was measured as the proportion of days covered ( PDC ) on antidepressant treatment. Patients with PDC ≥ 80% were considered adherent. Persistence was measured as the duration of time from initiation to a 30‐day gap in antidepressant treatment. Multivariate logistic regression and C ox‐proportional hazard models examined the influence of titration on adherence and persistence, respectively. Results Adherence was greater in the titration group than in the nontitration group (67.5% versus 45.2%, P < .01). After adjustment for selected covariates, patients in the titration group were more likely to adhere to antidepressant treatments (odds ratio = 2.60, 95% confidence interval ( CI ) = 2.47–2.74) and less likely to have a 30‐day gap in treatment (hazard ratio = 0.48, 95% CI = 0.45–0.51). Conclusions Upward dose titration on antidepressant treatments was associated with improved medication adherence and persistence. For clinicians initiating antidepressant treatment, titrating antidepressant doses may improve patient outcomes.