The association between antidepressant dosage titration and medication adherence among patients with depression

Depression and Anxiety, 05/03/2012

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.

Methods

  • The authors conducted a retrospective observational cohort study using Thomson Reuters MarketScan Commercial Claims and Encounters Claims data.
  • They identified 40,873 patients aged 18-64 with MDD newly initiating a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, or bupropion between July 1, 2005 and June 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 Cox-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).

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