COMPLIANCE IN DEPRESSED-PATIENTS TREATED WITH FLUOXETINE OR AMITRIPTYLINE

Two dimensions of compliance (drop-outs and adherence) were investigat ed in patients treated with antidepressant drugs. Efficacy, compliance and its determinants were investigated in 66 patients suffering from major depressive disorder and treated in a double-blind manner with fl uoxetine 20 mg/day or amitriptyline 150 mg/day for 9 weeks. Overall ef fectiveness [50% decrease in the initial Hamilton Rating Scale for Dep ression (HAM-D)] was similar in both groups (62.8% for fluoxetine, 58. 1% for amitriptyline). The dropout rate due to side effects was 35.5% for amitriptyline and 5.7% for fluoxetine. A logistic regression analy sis revealed that the initial HAM-D score was not predictive for dropp ing out, but this outcome was instead determined by sex (increased ris k for males), age (increased risk for being younger) and occurrence of severe side effects. Adherence was estimated using electronic Medicat ion Event Monitoring System and defined as the percentage of days when the correct dose was taken out of the medication container. Of the pa tients studied 37% had an adherence of less than 70%. There was no rel ationship between adherence and efficacy and adherence was similar in patients on fluoxetine or amitriptyline. Side effects were not predict ive of being adherent or not, but a higher initial HAM-D score predict ed a higher adherence to the medication regimen. The demographic varia bles had no significant effect. The present study suggests that the li nk between efficacy, side effects and compliance or adherence is more complex than is generally believed and that early termination and non- adherence seem to be determined by different factors. (C) 1998 Rapid S cience Ltd.