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Persistence and compliance to antidepressant treatment in patients with depression: A chart review

Norifusa Sawada12*, Hiroyuki Uchida234, Takefumi Suzuki25, Koichiro Watanabe2, Toshiaki Kikuchi2, Takashi Handa1 and Haruo Kashima2

Author Affiliations

1 Department of Psychiatry, Saiseikai Central Hospital 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan

2 Department of Neuropsychiatry, Keio University, School of Medicine35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

3 Department of Psychiatry, University of Toronto250 College Street, Toronto, Ontario, M5T 1R8, Canada

4 Geriatric Mental Health Program, Centre for Addiction and Mental Health1001 Queen Street West, Toronto, Ontario, M6J 1H4, Canada

5 Department of Psychiatry, Inokashira Hospital 4-14-1 Kamirenjaku, Mitaka-shi, Tokyo, 181-8531, Japan

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BMC Psychiatry 2009, 9:38  doi:10.1186/1471-244X-9-38

Published: 16 June 2009



Adherence has recently been suggested to be divided into these two components: persistence (i.e., whether patients continue treatment or not) and compliance (i.e., whether patients take doses as instructed). However, no study has yet assessed these two clinically relevant components at the same time in adherence to antidepressant treatment in the clinical outpatient setting.


In this retrospective chart-review, 6-month adherence to antidepressants was examined in 367 outpatients with a major depressive disorder (ICD-10) (170 males; mean ± SD age 37.6 ± 13.9 years), who started antidepressant treatment from April 2006 through March 2007. Additionally, we evaluated Medication Possession Rate (MPR), defined as the total days a medication was dispensed to patients divided by the treatment period.


Only 161 patients (44.3%) continued antidepressant treatment for 6 months. Among 252 patients who discontinued their initial antidepressant, 63.1% of these patients did so without consulting their physicians. Sertraline use was associated with a higher persistence rate at month 6 (odds ratio 2.59 in comparison with sulpiride), and the use of anxiolytic benzodiazepines had a positive effect on persistence to antidepressant treatment only at month 1 (odds ratio 2.14). An overall MPR was 0.77; 55.6% of patients were considered compliant (i.e., a MPR of ≥ 0.8).


Given a high rate of antidepressant discontinuation without consulting their physicians, closer communication between patients and their physicians should be encouraged. Although the use of anxiolytic benzodiazepines was associated with a higher persistence to antidepressant treatment at month 1, the use of these drugs should be avoided as a rule, given their well-known serious adverse effects.