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Clinical Trial
. 1999 Sep 4;319(7210):612-5.
doi: 10.1136/bmj.319.7210.612.

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

R Peveler  1 , C George, A L Kinmonth, M Campbell, C Thompson
Affiliations
Clinical Trial

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

R Peveler et al. BMJ. .

Abstract

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.

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Figure 1
Survival analysis of adherence to antidepressant treatment in patients allocated to drug counselling and no counselling
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