Brief report Adherence to continuation and maintenance antidepressant use in recurrent depression Mascha C. ten Doesschate a,b, ⁎ , Claudi L.H. Bockting c , Aart H. Schene a a Academic Medical Centre, Department of Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands b Mentrum Mental Health Organization, Amsterdam, The Netherlands c University of Groningen, Department of Clinical and Developmental Psychology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands Received 22 March 2008; received in revised form 17 July 2008; accepted 17 July 2008 Available online 28 August 2008 Abstract 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 prospectively 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 don't seem to be able or willing to take AD as prescribed, alternatives to prevent relapse deserve more attention. © 2008 Elsevier B.V. All rights reserved. Keywords: Non-adherence; Antidepressants; Recurrent depression; Continuation and maintenance phase 1. Introduction Non-adherence undermines optimal treatment and is in mental health care a risk factor for suicide (Meehan et al., 2006). Without prophylactic treatment up to 80% of patients with Major Depressive Disorder (MDD) will have further episodes (Frank et al. 1990). So, for patients with recurrent MDD, clinical guide- lines recommend maintenance antidepressant (AD) use for at least 2 years to prevent relapses (National Institute for Clinical Excellence, 2004). For them, like in other chronic diseases long-term adherence to medi- cation might be a problem (Osterberg and Blaschke, 2005). Hitherto, research on AD (non-)adherence in Journal of Affective Disorders 115 (2009) 167 – 170 www.elsevier.com/locate/jad ⁎ Corresponding author. Academic Medical Centre, Department of Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 20 8913607. E-mail addresses: m.c.tendoesschate@amc.uva.nl, mascha_ten@hotmail.com (M.C. ten Doesschate). 0165-0327/$ - see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2008.07.011