Antidepressant retention and adherence among Latinx outpatients with major depressive disorder: The effect of a novel motivational interviewing-consistent approach to pharmacotherapy.
Roberto Lewis-Fernández, Peter C Lam, Dolly A John et al.
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In 30 seconds
This 36-week randomized controlled trial compared motivational pharmacotherapy (MPT), a motivational interviewing-consistent approach, with standard pharmacotherapy in 195 Latinx outpatients with at-least-moderately-severe major depressive disorder. MPT reduced early medication discontinuation during the first month (RR = 0.47; 95%CI:0.25, 0.90) and increased treatment completion or late discontinuation in weeks 32-36 (RR = 1.19; 95%CI:1.003, 1.41), but did not significantly improve retention across the full 36 weeks. Effects on adherence and several functional and symptom measures were nonsignificant, although remission improved.
Key findings
- First-month medication discontinuation was lower with MPT (RR = 0.47; 95%CI:0.25, 0.90).
- Treatment completion or late discontinuation in weeks 32-36 was higher with MPT (RR = 1.19; 95%CI:1.003, 1.41), but overall 36-week retention did not differ significantly.
- Among participants without prior antidepressant history, discontinuation was reduced (HR = 0.56; 95%CI:0.36, 0.88); among those with adequate prior treatment, it increased at the trend level (HR = 2.33; 95%CI:0.94, 5.82).
- Adherence, continuous MDD symptom scores, disability, and quality of life did not significantly improve; MDD remission did.
Why it matters
Medication disengagement can undermine depression treatment. These findings suggest that a communication approach designed to address ambivalence may help patients remain on medication during the early treatment period, particularly those without prior antidepressant experience. The absence of an overall retention benefit and the differing subgroup results indicate that effects may depend on treatment history and should be interpreted cautiously.
What to keep in mind
The trial found no significant improvement in overall retention across 36 weeks, and several measured outcomes, including adherence and continuous symptom scores, were nonsignificant.