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Cited by 76Medication Adherence and ComplianceTreatment of Major DepressionPsychotherapy Techniques and Applications

Response, remission and relapse in relation to adherence in primary care treatment of depression: a 2-year outcome study

Åkerblad, Ann-Charlotte, Bengtsson, Finn, von Knorring, Lars, Ekselius, Lisa·2006·International Clinical Psychopharmacology
DOI 10.1097/01.yic.0000199452.16682.b8
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Abstract

Non-adherence to antidepressant drug treatment is common. In a recent study in depressed primary care patients, we reported a strong relationship between adherence and response after 6 months. With the use of a naturalistic design, the patients in that study were prospectively followed for 2 years. The purpose of the present study was to investigate the patients' long-term outcome and, in particular, to examine the impact of patients' treatment adherence on response, remission and relapse. Of the 1031 patients in the intent-to-treat (ITT) sample, 835 completed the study. After 2 years, the overall remission rate defined as a Montgomery-Asberg Depression Rating Scale score of nine or less was 68% in the ITT sample analysed with the last observation carried forward (LOCF) technique, and 75% in observed cases. In total, 34% of the responders experienced at least one relapse. Response rates (LOCF) were significantly higher in adherent compared to non-adherent patients at week 24 [95% confidence interval (CI) = 21.4-32.1], year 1 (95% CI = 12.3-22.2) and year 2 (95% CI = 9.2-19.0). Remission rates (LOCF) were also significantly higher in the group of adherent patients at week 24 (95% CI = 9.6-21.5), year 1 (95% CI = 10.0-21.5) and year 2 (95% CI = 11.0-22.0). No relationship between adherence and relapse rate was observed, although the mean time from response to first sign of relapse was significantly longer in the adherent patients (95% C I= 9-97 days). In conclusion, this 2-year follow-up study showed superior long-term recovery in patients who were adherent to antidepressant medication compared to non-adherent patients.

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  • 20 articles define relapse with psychometric measures (Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery-Asberg Depression Rating Scale, Goldberg Anxiety and Depression Scale, Clinical Global Impression).

    “20 do so with psychometric measures (Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery-Asberg Depression Rating Scale, Goldberg Anxiety and Depression Scale, Clinical Global Impression) (4, 7, 9, 13–18, 33, 34, 42–49)”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [33]

  • 4 studies use the Clinical Global Impression (CGI-S), 2 use the Beck's Depression Inventory, and 1 uses the Goldberg Anxiety and Depression Scale (GADS).

    “Finally, 4 studies use the Clinical Global Impression (CGI-S) (15, 33, 43, 48), 2 use the Beck`s Depression Inventory (4, 9) and 1 uses the Goldberg Anxiety and Depression Scale (GADS) (20).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [33]

  • The second criterion with which most authors agree is antidepressant treatment, with some mentioning it in general and others specifying change, upward adjustment, review, or potentiation.

    “The second criterion with which most authors agree is that related to antidepressant treatment, although some mention it in general (27, 33) and others specify whether they consider a change of antidepressant (8, 15, 26, 34, 40, 42, 48, 50), an upward adjustment (10, 17, 40, 45), a review of the treatment (24) or a potentiation (17).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [33]

  • The extracted medians showed substantial heterogeneity, ranging from very early relapse in severe or treatment-resistant samples with medians between 53 and 90 days to substantially longer intervals in maintenance-treated populations (218-294 days).

    “The extracted medians showed substantial heterogeneity, ranging from very early relapse in severe or treatment−resistant samples with medians between 53 and 90 days (14, 21, 23, 38) to substantially longer intervals in maintenance−treated populations (218–294 days) (33, 40, 45).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [33]

  • Suicide/suicide attempt is mentioned 19 times as an administrative criterion.

    “Suicide/suicide attempt is mentioned 19 times (1, 15, 16, 18, 19, 26, 27, 33, 37, 38, 41, 43–46, 48–50, 52)”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [33]

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Authors
Åkerblad, A.-C., Bengtsson, F., von Knorring, L., & Ekselius, L.
Affiliations
  • Uppsala University (SE)
  • Linköping University (SE)
Corresponding author
Åkerblad, Ann-Charlotte
ORCID
Ekselius, Lisa
Venue
International Clinical Psychopharmacology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-03
Volume
21
Issue
2
Pages
117-124
ISSN
0268-1315 (ISSN-L)
DOI
10.1097/01.yic.0000199452.16682.b8
OpenAlex
W1964388294
Cited by
76
References
35
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 5 · 2020: 3 · 2019: 4 · 2018: 1 · 2017: 5 · 2016: 3 · 2015: 5 · 2014: 5 · 2013: 4 · 2012: 5
FWCI
2.70
Type
journal article
Language
en
Open access
closed
Locations
  • International Clinical Psychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Pfizer
  • Vetenskapsrådet
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
depression, antidepressant adherence, medication non-adherence, relapse, remission, treatment response, long-term outcomes, primary care, antidepressant treatment
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Antidepressive Agents, Depressive Disorder, Female, Humans, Male, Middle Aged, Patient Compliance, Primary Health Care, Prospective Studies, Recurrence, Severity of Illness Index, Treatment Outcome

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