***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND In chronic diseases adherence is a problem . Little is known about adherence to antidepressants after the acute phase in recurrent depression . This study evaluates adherence to antidepressants in the continuation and maintenance phase in remitted recurrently depressed patients . METHODS We prospect ively assessed adherence to continuation and maintenance antidepressant use , the longest phase in antidepressant treatment , over 2 years and the association of adherence with future recurrence in 131 recurrently depressed patients remitted on antidepressants . LIMITATIONS Self reported non-adherence . RESULTS Non-adherence ranged from 39.7 % to 52.7 % ; 20.9 % were always non-adherent , 48.4 % were intermittently non-adherent and 30.8 % were always adherent . Adherence rates did not significantly differ between intermittent and continuous antidepressant users ( 37.2 % vs. 25 % ) . Non-adherence predicted time to recurrence . CONCLUSION Non-adherence to continuation and maintenance antidepressant treatment in recurrent depression is frequent , like in other chronic diseases , and a potential risk of recurrence . Doctors continuously have to be aware of this problem and should keep on discussing it with their patients . Finally , as many patients do n't seem to be able or willing to take AD as prescribed , alternatives to prevent relapse deserve more attention AIMS To assess the advantages and disadvantages of four methods for study ing compliance with antidepressants : self-report scores , tablet counts , a microprocessor ( MEMS ) container system and the assay of nordothiepin and dothiepin concentrations in plasma . METHODS The techniques were used in 88 patients commencing tricyclic antidepressants in the setting of UK general practice . RESULTS The MEMS system proved to be the most informative technique allowing identification of the precise time of container opening , the demonstration of ' drug holidays ' and early cessation of therapy . Self-report scores ( Morisky ) proved a useful screening technique with a sensitivity of 72.2 % and specificity of 74.1 % for > or = 80 % compliance . Although tablet counts were possible in 84 patients ( 95 . 5 % ) they were unreliable in 19 ( 21.6 % ) . Blood concentration assays proved the least acceptable method to patients and were possible in only 53 ( 60.2 % ) . A ratio of nordothiepin : dothiepin > or = 1.1 cl aim ed , by others , to identify noncompliance was only reliable when concentrations were low . CONCLUSIONS Both the MEMS system and self-report scores proved useful methods for identifying noncompliant patients in the setting of UK general practice . Although compliance was higher than reported in previous studies with 70 patients ( 79.5 % ) completing 6 weeks treatment , general practitioners tended to prescribe subtherapeutic doses BACKGROUND This research study evaluates the effectiveness of a multifaceted intervention program to improve the management of  depression  in primary care . METHODS One hundred fifty-three primary care patients with current depression were entered into a r and omized controlled trial . Intervention patients received a structured depression treatment program in the primary care setting that included both behavioral treatment to increase use of adaptive coping strategies and counseling to improve medication adherence . Control patients received " usual " care by their primary care physicians . Outcome measures included adherence to antidepressant medication , satisfaction with care of depression and with antidepressant treatment , and reduction of depressive symptoms over time . RESULTS At 4-month follow-up , significantly more intervention patients with major and minor depression than usual care patients adhered to antidepressant medication and rated the quality of care they received for depression as good to excellent . Intervention patients with major depression demonstrated a significantly greater decrease in depression severity over time compared with usual care patients on all 4 outcome analyses . Intervention patients with minor depression were found to have a significant decrease over time in depression severity on only 1 of 4 study outcome analyses compared with usual care patients . CONCLUSION A multifaceted primary care intervention improved adherence to antidepressant regimens and satisfaction with care in patients with major and minor depression . The intervention consistently result ed in more favorable depression outcomes among patients with major depression , while outcome effects were ambiguous among patients with minor depression Measurement of adherence is complex and many methods , both direct and indirect are used ; there is no universal gold st and ard . In this article , we share our experiences in a r and omised controlled study , the Hypertension Adherence Program in Pharmacy trial , evaluating a  community pharmacy-based intervention for improving  adherence  to antihypertensive medication .  Several objective and subjective measures of adherence ( Morisky score , TABS score , MedsIndex , Medicines Possession Ratio ) were used , but produced varying results , limiting confidence in the conclusions that could be drawn . Despite using a specifically design ed data mining software program to identify potentially nonadherent patients from dispensing records , many participants were found to be adherent by the self reported Morisky scale . A lesson to be learned when targeting people for interventions to improve adherence is that information from dispensing records should be supplemented by other methods in order to identify patients most in need of assistance PURPOSE The impact of pharmacist interventions on the care and outcomes of patients with depression in a primary care setting was evaluated . METHODS Patients diagnosed with a new episode of depression and started on anti-depressant medications were r and omized to enhanced care ( EC ) or usual care ( UC ) for one year . EC consisted of a pharmacist collaborating with primary care providers to facilitate patient education , the initiation and adjustment of antidepressant dosages , the monitoring of patient adherence to the regimen , the management of adverse reactions , and the prevention of relapse . The patients in the UC group served as controls . Outcomes were measured by the Hopkins Symptom Checklist , Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for major depression , health-related quality of life , medication adherence , patient satisfaction , and use of depression-related health care services . An intent-to-treat analysis was used . RESULTS Seventy-four patients were r and omized to EC or UC . At baseline , the EC group included more patients diagnosed with major depression than did the UC group ( p = 0.04 ) . All analyses were adjusted for this difference . In both groups , mean scores significantly improved from baseline for symptoms of depression and quality of life at three months and were maintained for one year . There were no statistically significant differences between treatment groups in depression symptoms , quality of life , medication adherence , provider visits , or patient satisfaction . CONCLUSION Frequent telephone contacts and interventions by pharmacists and UC in a primary care setting result ed in similar rates of adherence to antidepressant regimens and improvements in the outcomes of depression at one year BACKGROUND A new formulation of enteric-coated fluoxetine given once weekly could be a useful option for the long-term treatment of depression , but compliance to once-weekly fluoxetine treatment has not been assessed . METHOD Patients were adults from the United Kingdom who had responded to fluoxetine treatment for a current episode of depression ( DSM-IV criteria ) . In the baseline assessment phase , all patients ( N = 117 ) were continued on 20 mg of open-label fluoxetine once daily for 4 weeks . In the follow-up phase , patients ( N = 109 ) were r and omly assigned to once-weekly or once-daily fluoxetine for 3 months . Patient compliance was monitored by electronic devices during both phases of the study . RESULTS Compliance to once-weekly fluoxetine treatment was higher than compliance to once-daily fluoxetine ( 85.9 % vs. 79.4 % , respectively ) . CONCLUSION Once-weekly fluoxetine treatment allows for new flexibility for both the clinician and the patient , and this study alleviates the concern that patients will forget weekly doses The goals of this study were to examine how physician communication style impacts client beliefs and medication taking behavior during treatment for depression . The study uses a communication framework and prospect i ve design to examine  physician communication  and client beliefs as treatment is initiated and again 2 months later . Two telephone interviews were conducted with 100 clients enrolled from 23 community pharmacies . Clients report that physician communication styles vary . In follow-up , 25 % of the clients were not satisfied with their medication and 82 % reported missing doses or stopping treatment earlier than recommended . Path analysis showed that physician initial communication style positively influences client knowledge and initial beliefs about the medication . Clients with more positive beliefs about the treatment are more likely to see the physician in follow-up and are more satisfied with treatment after attempting medication use . Physician follow-up communication style and client satisfaction are both predictive of better medication adherence Abstract Objectives : To evaluate two different methods of improving adherence to antidepressant drugs . Design : Factorial r and omised 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 . Key messages Non-adherence is a serious problem in the treatment of depression by general practitioners In this study a brief psychosocial intervention delivered by a nurse greatly improved adherence Clinical benefit was apparent only in patients with major depressive episodes on higher doses of drugs Counselling should be targeted at patients with symptoms of at least moderate severity and combined with therapeutic drug Medication non-adherence is a major obstacle in the treatment of affective disorders . The primary objective of this study was to evaluate two different interventions to improve adherence to antidepressant drugs .  Secondary objectives included response to treatment , relation between adherence and response , patient satisfaction and tolerability . A r and omized controlled design was used to assess the effect of a patient educational compliance enhancing programme ( CP ) and therapeutic drug monitoring in 1031 major depressed patients treated with sertraline for 24 weeks and managed by their general practitioner .  Adherence was measured by question ing , measurable serum levels of sertraline and desmethylsertraline , appointments kept and a composite index including all three methods . Treatment adherence was found in 37–70 % of patients , depending on the method used . Neither of the interventions result ed in a significant increase in adherence rate . However , significantly more patients in the CP group had responded at week 24 compared to patients in the control group . Overall , significantly more adherent patients responded to treatment compared to non-adherent patients , regardless of method used to determine adherence . This large study demonstrates that treatment response increases when using an educational compliance programme and that a strong relationship between treatment adherence and response exists The effects on adherence and depressive symptoms of a community pharmacy-based coaching program , including a take-home videotape , were evaluated in a r and omized controlled trial in the Netherl and s. A total of 147 depressed primary care patients who had a new antidepressant prescription were included in the study . Adherence was measured with an electronic pill container and was also derived from pharmacy medication records ; the latter method was associated with an overestimation of adherence of only 5 percent . Intention-to-treat analyses showed no intervention effect on adherence ( 73 percent compared with 76 percent ) , whereas analyses of patients who received the intervention ( per protocol ) showed improved adherence ( 73 percent compared with 90 percent ) . Neither analysis showed effects on depressive symptoms Background : Medication adherence is suboptimal , and clinicians and research ers struggle with identifying nonadherent patients . Various measures of medication adherence exist , but there is controversy regarding which measures provide acceptable data and how nonadherence should be defined . Objective : To assess agreement among patient self-report , pharmacy refill , and electronic adherence measures and compare the sensitivity and specificity of different cut-points for defining nonadherence . Methods : Data were analyzed from 2 similarly design ed r and omized controlled trials that assessed a  pharmacist 's intervention to improve medication adherence among patients with hypertension or heart failure . For each participant , adherence was measured by patient self-report , prescription refill records , and electronic lids on medication containers . Agreement among measures was assessed using Spearman 's correlation coefficient rho . Correlation coefficients were compared by patient characteristics using Fisher 's Z transformation , The sensitivity and specificity of different cut-points for defining nonadherence were calculated . Results : Median adherence was 84 % for self-report , 86 % for electronic , and 91 % for prescription refill adherence measurement . Refill and electronic adherence demonstrated the best agreement among measures ( rho = 0.48 ) . Age , depression , and other comorbid conditions 
    Output:
    
Self‐report measures were the most frequently used , followed by electronic lid devices and pharmacy records .
St and ardized self‐report measures such as Morisky , Green , and Levine Self‐Reported Medication Taking Scale ( MGLS ) and Antidepressant Adherence Scale ( AAS ) demonstrated acceptable reliability and validity , while medication cl aims data showed good reliability as a long‐term measure .
Conclusions : Although the psychometric properties of various measures have been evaluated across the three phases of adherence , a st and out measure with strong reliability and validity was not apparent .
No single measure demonstrated reliability and validity throughout the adherence process .