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 2.7, 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 ⩾75 mg. Further research is required to evaluate the effect of this approach in combination with appropriate targeting of treatment and advice about dosage.