Web-Based Program to Improve Antidepressant Medication Adherence

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DESCRIPTION (provided by applicant): Mood disorders, including major depressive disorder, dysthymia, and bipolar disorder, affect nearly 21 million Americans or 9.5% of the U.S. population age 18 years of age and older. Among mental health problems, major depressive disorder is the leading cause of disability in the U.S. for people ages 15-44, affecting nearly 15 million adults each year. While research has clearly shown the efficacy of antidepressant medication for treating major depression when medications are taken in accordance with national guidelines, that efficacy is compromised when patients do not take medications as prescribed. Estimates for non-adherence to antidepressant medications range from 20% to 59%. Reasons for non-adherence range from adverse side effects, clinical improvement prior to completing treatment course, fear of dependence, discomfort with taking psychotropic medications, lack of treatment effectiveness, and desire to solve problems without drugs. Many interventions have been implemented in an attempt to improve patient adherence to treatment regimens, but the most effective programs are often are often complex and labor intensive leading McDonald and her colleagues to conclude that more studies of innovative methods are needed. ISA Associates, in partnership with Aetna Behavioral Health Care and the Redmon Group, proposes to develop and pilot test a prototype web-based antidepressant medication adherence program, Life Steps for Depression, for individuals diagnosed with major depressive disorder and prescribed antidepressant medication. The prototype will be based on Safren's successful Life Steps medication adherence approach. Once the prototype is developed, it will be pilot tested with a sample of 60 Aetna Behavioral Health members who are newly prescribed antidepressant medication and have a corresponding diagnosis of major depressive disorder. Because of the limited nature of the prototype, in which only a sample of the final program content will be fully developed, feasibility will be based on self-reported outcome measures related to the prototype content. These measures will include knowledge of depression, medications, and adherence; perceived efficacy in patient-physician interactions; coping with side effects; medication adherence self-efficacy; [and medication adherence]. Participants will complete the survey at baseline and two months. Phase I milestones and benchmarks for proceeding to Phase II are described. If shown effective, the web-based Life Steps for Depression would be available to all individuals prescribed antidepressant medications for depression with access to the Internet, greatly expanding the reach of medication adherence programs. The proposed research team including Drs. Hersch and Billings have successfully created and tested several web-based behavioral health programs, including Smart Rx (a prescription drug misuse prevention program) and Stress and Mood Management (which addresses stress, depression, anxiety, and treatments that work). Drs. Hersch and Billings will be assisted by Dr. Steve Safren, Associate Professor in Psychology, Harvard Medical School and developer of the Life Steps approach, and Dr. Wayne Katon, Professor of Psychiatry and Vice Chair of the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical Center. PUBLIC HEALTH RELEVANCE: Clinical evidence now shows that there are safe and effective antidepressant medications that can be used to treat major depressive disorder. However, many individuals fail to complete the minimum recommended six month treatment regimen for a wide variety of reason. Recent data suggests that there are collaborative care and telephone outreach approaches that can increase medication compliance and improve clinical outcomes. Unfortunately, the reach of these interventions is limited by their cost and relative inaccessibility. The outcome of this Phase I project will be a prototype of an innovative, web-based medication adherence program for individuals diagnosed with major depressive disorder who are being treated with antidepressant medications. Such a program, if effective, will greatly expand access to an effective medication adherence program, thereby improving the clinical outcomes of people with depression and reducing the likelihood of depression relapse.