Non-adherence with psychotropic medications in the general population

Original Paper

Abstract

Background

Non-adherence with medications is a general medical issue that has received much attention. However, the majority of studies have been on various clinical populations and the relevance of their results to the general population is unknown. In this study, we sought to determine the degree of non-adherence with antidepressants, antipsychotics, anxiolytics, mood stabilizers and sedative hypnotics, and to determine the reasons for non-adherence, in the general population of Canada.

Methods

We used data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), conducted in 2002 (n = 36,984 adults), to produce population-based estimates of the degree of reported non-adherence with psychotropic medications and the reasons for non-adherence.

Results

The number of individuals taking psychotropic medications was 6,201. The prevalence of antipsychotic use over the last 12 months was estimated at 0.4% (95% CI 0.3–0.4). The corresponding estimates for sedative-hypnotics, anxiolytics, mood stabilizers and antidepressants were 10.2% (95% CI 9.8–10.7), 5.5% (95% CI 5.2–5.8), 1.1% (1.0–1.3) and 5.8% (95% CI 5.5–6.2), respectively. Non-adherence was estimated to be 34.6% (95% CI 25.5–44.9) for antipsychotics, 34.7% (95% CI 32.2–37.4) for sedative-hypnotics, 38.1% (95% CI 35.0–41.4) for anxiolytics, 44.9% (95% CI 38.1–51.9) for mood stabilizers and 45.9% (95% CI 43.1–48.7) for antidepressants. The degree of non-adherence decreased with age for antidepressants and anxiolytics. Forgetting was the main reported reason for non-adherence, but its degree varied with medication class. The proportion of respondents that reported forgetting as a reason was 36.3% (95% CI 32.0–40.8) for sedative-hypnotics, 46.7% (95% CI 41.3–52.2) for anxiolytics, 72.7% (95% CI 55.5–85.0) for antipsychotics, 74.2% (95% CI 64.0–82.3) for mood stabilizers and 74.5% (95% CI 70.7–77.9) for antidepressants. The degree of non-adherence and the frequency of forgetting were not associated with the level of interference by the associated condition with usual activities. The majority of these estimates were also not impacted by educational status, employment status, rural/urban residence, income or the presence of a comorbid physical condition.

Conclusion

A high frequency of non-adherence was found with all five classes of psychotropic medication. Both the frequency of reported non-adherence and the reasons reported for it differ according to the medication. However, the degree of non-adherence was not affected by the level of interference of the associated condition.

Keywords

Adherence Psychotropic medication Health survey Epidemiological studies 

Notes

Acknowledgments

Permission to access the CCHS 1.2 Master File was granted by the Social Sciences and Humanities Research Council of Canada. We thank Jeanne Williams for assistance with Stata programming.

References

  1. 1.
    Adler DA, Bungay KM, Wilson IB, Pei Y, Supran S, Peckham E, Cynn DJ, Rogers WH (2004) The impact of a pharmacist intervention on 6-month outcomes in depressed primary care patients. Gen Hosp Psych 26:199–209CrossRefGoogle Scholar
  2. 2.
    Akerblad AC, Bengtsson F, Ekselius L, von Knorring L (2008) Effects of an educational compliance enhancement programme and therapeutic drug monitoring on treatment adherence in depressed patients managed by general practitioners. Int Clin Psychopharmacol 18:347–354CrossRefGoogle Scholar
  3. 3.
    Akerblad AC, Bengtsson F, von Knorring L, Ekselius L (2006) Response, remission and relapse in relation to adherence in primary care treatment of depression: a 2-year outcome study. Int Clin Psychopharm 21:117–124CrossRefGoogle Scholar
  4. 4.
    Anderson IM, Tomenson BM (1995) Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. Brit Med J 310:1433–1438PubMedGoogle Scholar
  5. 5.
    Barlow JH, Turner AP, Wright CC (1998) Comparison of clinical and self-reported diagnoses for participants on a community-based arthritis self-management program. Br J Rheumatol 37:985–987CrossRefPubMedGoogle Scholar
  6. 6.
    Blackwell B (1996) From compliance to alliance: a quarter century of research. Neth J Med 48:140–149PubMedGoogle Scholar
  7. 7.
    Brown CB, Battista DR, Bruelman R, Sereika SS, Thase ME, Dunbar-Jacob J (2005) Beliefs about antidepressant medications in primary care patients. Relationship to self-reported adherence. Med Care 43:1203–1207CrossRefPubMedGoogle Scholar
  8. 8.
    Bulloch AGM, Adair CE, Patten SB (2006) Forgetfulness: A role in non-compliance with antidepressant treatment. Can J Psychiatry 51:719–722PubMedGoogle Scholar
  9. 9.
    Bulloch AGM, Patten SB (2008) Non-remission of depression in the general population as assessed by the HAMD-7 scale. Depress Anxiety 25:393–397CrossRefPubMedGoogle Scholar
  10. 10.
    Cantrell CR, Eaddy MT, Shah MB, Regan TS, Sokol MC (2006) Methods for evaluating patient adherence and economic outcomes. A real-world comparison of adherence and economic outcomes. Med Care 22:300–303CrossRefGoogle Scholar
  11. 11.
    Chakraborty K, Avasthi A, Kumar S, Grover S (2008) Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-008-0468-0
  12. 12.
    Cohen NL, Ross EC, Bagby RM, Farvolden P, Kennedy SH (2004) The 5-factor model of personality and antidepressant medication compliance. Can J Psych 49:106–113Google Scholar
  13. 13.
    Compton MT, Rudish BE, Weiss PS, West JC, Kaslow SH (2005) Predictors of psychiatrist-reported treatment-compliance problems among patients in routine US psychiatric care. Psychiatry Res 2005 137:29–36CrossRefGoogle Scholar
  14. 14.
    Cooper LA, Brown C, Vu HT et al (2000) Primary care patients’ opinions regarding the importance of various aspects of care for depression. Gen Hosp Psychiatry 22:163–173CrossRefPubMedGoogle Scholar
  15. 15.
    Cooper LA, Gonzales JJ, Gallo JJ et al (2003) The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Med Care 41:479–489CrossRefPubMedGoogle Scholar
  16. 16.
    Cramer JA, Spilker B (1991) Patient compliance in medical practice and clinical trials. Raven press, New YorkGoogle Scholar
  17. 17.
    Cramer JA (1995) Optimizing long-term patient compliance. Neurology 45:S25–S28PubMedGoogle Scholar
  18. 18.
    Cramer JA, Rosenheck R (1998) Compliance with medication regimens for mental and physical disorders. Psychiatr Serv 49:196–201PubMedGoogle Scholar
  19. 19.
    Cramer JA, Rosenheck R (1999) Enhancing medication compliance for people with serious mental illness. J Nerv Ment Dis 187:53–55CrossRefPubMedGoogle Scholar
  20. 20.
    Demyttenaere K (1997) Compliance during treatment with antidepressants. J Affect Disord 43:27–39CrossRefPubMedGoogle Scholar
  21. 21.
    Demyttenaere K (2003) Risk factors and predictors of compliance in depression. Eur Neuropsychopharmacol 13(suppl 3):S69–S75CrossRefPubMedGoogle Scholar
  22. 22.
    Demyttenaere K, Enzlin P, Dewe W, Boulanger B, De Bie J, De Troyer W, Mesters P (2001) Compliance with antidepressants in a primary care setting, 1: beyond lack of efficacy and adverse events. J Clin Psychiatry 62(suppl 22):30–33PubMedGoogle Scholar
  23. 23.
    Demyttenaere K, Enzlin P, Dewe W, Boulanger B, De Bie J, De Troyer W, Mesters P (2001) Compliance with antidepressants in a primary care setting, 2: the influence of gender and type of impairment. J Clin Psychiatry 62(suppl 22):34–37PubMedGoogle Scholar
  24. 24.
    Demyttenaere K, Mesters P, Boulanger B, Dewe W, Delsemme MH, Gregoire J, Van Ganse E (2001) Adherence to treatment regimen in depressed patients treated with amitriptyline or fluoxetine. J Affect Disord 65:243–252CrossRefPubMedGoogle Scholar
  25. 25.
    Demyttenaere K, Van Ganse E, Gregoire J, Gaens E, Mesters P (1998) Compliance in depressed patients treated with fluoxetine or amitriptyline. Int Clin Psychopharmacol 13:11–17PubMedGoogle Scholar
  26. 26.
    Dolder CR, Lacro JP, Leckband S, Jeste DV (2003) Interventions to improve antipsychotic medication adherence: review of recent literature. J Clin Psychopharmacol 23:389–399CrossRefPubMedGoogle Scholar
  27. 27.
    Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, Jeste DV (2004) Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. Am J Psychiatry 161:692–699CrossRefPubMedGoogle Scholar
  28. 28.
    Gopinath S, Katon WJ, Russo JE, Ludman EJ (2007) Clinical factors associated with relapse in primary care patients with chronic or recurrent depression. J Affect Dis 101:57–63CrossRefPubMedGoogle Scholar
  29. 29.
    Gravel R, Beland Y (2005) The Canadian Community Health Survey: Mental Health and Well-Being. Can J Psychiatry 10:573–579Google Scholar
  30. 30.
    Hansen HV, Kessing LV (2007) Adherence to antidepressant treatment. Expert Rev Neurother 7:57–62CrossRefPubMedGoogle Scholar
  31. 31.
    Hoffman L, Enders J (2003) Impact of an antidepressant management program on medication adherence. Am J Man Care 9:70–80Google Scholar
  32. 32.
    Katon W, Von Korff M, Lin E, Walker E, Simon GE, Bush T, Robinson P, Russo J (1995) Collaborative management to achieve treatment guidelines. Impact on depression in primary care. J Amer Med Assoc 273:1026–1031CrossRefGoogle Scholar
  33. 33.
    Keller MB, Hirschfeld RMA, Demyttenaere K, Baldwin DS (2002) Opimizing outcomes in depression: focus on antidepressant compliance. Int Clin Psychopharmacol 17:265–271CrossRefPubMedGoogle Scholar
  34. 34.
    Kessing LV, Hansen HV, Demyttenaere K, Bech P (2005) Depressive and bipolar disorders: patients’ attitudes and beliefs towards depression and antidepressants. Psychol Med 35:1205–1213CrossRefPubMedGoogle Scholar
  35. 35.
    Kriegsman DMW, Pennix BWJH, van Eijk JTM, Boeke AJP, Deeg DJH (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patient’s self-reports and on determinants of inaccuracy. J Clin Epidemiol 49:1407–1417CrossRefPubMedGoogle Scholar
  36. 36.
    Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV (2002) Prevalence of and risk factors for medication non-adherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 63:892–909PubMedGoogle Scholar
  37. 37.
    Lin EH, Von Korff M, Katon W, Bush T, Simon GE, Walker E, Robinson P (1995) The role of the primary care physician in patients’ adherence to antidepressant therapy. Med Care 1995 33:67–74Google Scholar
  38. 38.
    Lingham R, Scott J (2002) Treatment non-adherence in affective disorders. Acta Psychiatr Scand 105:164–172CrossRefGoogle Scholar
  39. 39.
    Maddox JC, Levi M, Thompson C (1994) The compliance with antidepressants in clinical practice. J Psychopharmacol 8:48–53CrossRefGoogle Scholar
  40. 40.
    Masand PS (2003) Tolerability and adherence issues in antidepressant therapy. Clin Ther 25:2289–2304CrossRefPubMedGoogle Scholar
  41. 41.
    Melfi CA, Chawla AJ, Croghan TW, Hanna MP, Kennedy S, Sredl K (1998) The effects of adherence to antidepressant guidelines on relapse and recurrence of depression. Arch Gen Psychiatry 55:1228–1232CrossRefGoogle Scholar
  42. 42.
    Osterberg I, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497CrossRefPubMedGoogle Scholar
  43. 43.
    Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C (2002) Patient adherence in the treatment of depression. Br J Psychiatry 180:104–109CrossRefPubMedGoogle Scholar
  44. 44.
    Sewitch MJ, Cole M, McCusker J, Ciampi A, Dyachenko A (2008) Medication use and nonadherence to psychoactive medication for mental health problems by community-living Canadian seniors with depression. Can J Psychiatry 53:609–620PubMedGoogle Scholar
  45. 45.
    Sheehan DV, Harnett-Sheehan K, Raj BA (1996) The measurement of disability. Int Clin Psychopharmacol 1996 11:89–95CrossRefGoogle Scholar
  46. 46.
    Simon GE, VonKorff M, Wagner EH, Barlow W (1993) Patterns of antidepressant use in community practice. Gen Hosp Psychiatry 15:399–408CrossRefPubMedGoogle Scholar
  47. 47.
    Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS (2001) Percieved stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Serv 52:1615–1620CrossRefGoogle Scholar
  48. 48.
    Steffens DC, Krishnan KR, Helms MJ (1997) Are SSRIs better than TCAs? Comparison of SSRIs and TCAs: a meta-analysis. Depress Anxiety 6:10–18CrossRefPubMedGoogle Scholar
  49. 49.
    Van Voorhees BW, Cooper LA, Rost KM et al (2003) Primary care patients with depression are less accepting of treatment than those seen by mental health specialists. J Gen Intern Med 18:991–1000CrossRefPubMedGoogle Scholar
  50. 50.
    Vergouwen AC, Bakker A, Katon WJ, Verheij TJ, Koerselman F (2003) Improving adherence to antidepressants: a systematic review of interventions. J. Clin Psych 64:1415–1420CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Community Health Sciences, Faculty of Medicine, Hotchkiss Brain InstituteUniversity of CalgaryCalgaryCanada

Personalised recommendations