Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial

Objectives To evaluate two different methods of improving adherence to antidepressant drugs. Design Factorial randomised controlled single blind trial of treatment leaflet, drug counselling, both, or treatment as usual. Setting Primary care in Wessex Participants 250 patients starting treatment with tricyclic antidepressants. Main outcome measures Adherence to drug treatment (by confidential self report and electronic monitor); depressive symptoms and health status. Results 66 (63%) patients continued with drugs to 12 weeks in the counselled group compared with 42 (39%) of those who did not receiving counselling (odds ratio 2.1, 95% confidence interval 1.6 to 4.8; number needed to treat = 4). Treatment leaflets had no significant effect on adherence. No differences in depressive symptoms were found between treatment groups overall, although a significant improvement was found in patients with major depressive disorder receiving drug doses of at least 75 mg (depression score 4 (SD 3.7) counselling v 5.9 (SD 5.0) no counselling P = 0.038). Conclusions Counselling about drug treatment significantly improved adherence, but clinical benefit was seen only in patients with major depressive disorder receiving doses greater than or equal to 75 mg. Further research is required to evaluate the effect of this approach in combination with appropriate targeting of treatment and advice about dosage.