Preliminary communication Concordance therapy: an intervention to help older people take antidepressants N. Higgins a, * , G. Livingston b , C. Katona c a South London and Maudsley NHS Trust, Section of Community Psychiatry (PriSM), Health Services Research Department, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK b Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, UK c Kent Institute of Medicine and Health Sciences, Canterbury, UK Received 14 April 2003; received in revised form 13 June 2003; accepted 8 July 2003 Abstract Background: Older people often do not adhere fully to antidepressant medication. Compliance Therapy improves adherence with antipsychotic medication. Objective: To adapt Compliance Therapy for use in older depressed patients, to pilot this ‘Concordance Therapy’ for feasibility and acceptability and to gain preliminary indications of its efficacy. Methods: Randomised controlled trial (RCT). Setting: Psychiatric services for older people in North London and Essex. Participants: A total of 19 older depressed patients. Intervention: 10 patients received Concordance Therapy over 3 – 4 sessions. Control: 9 patients received treatment as usual. Main outcome measure: medication adherence at 1 month. Secondary outcome measures: medication adherence at 3 months; depression severity, beliefs about medication, quality of life at 1 and 3 months; patient feedback about the therapy. Results: The therapy was acceptable to patients. Intervention patients were more likely to take antidepressants, had a higher quality of life, had less depressive symptomatology and were less likely to be cases of depression at 1 month. Beliefs around antidepressants at 1 month were more positive in the intervention group but this was not the case for medication in general. Limitations: As a pilot, patient numbers were small and the findings did not reach statistical significance. Three patients (1 intervention, 2 control) were in hospital and therefore offered medication at follow-up. Conclusion: Concordance Therapy for older people prescribed antidepressants is acceptable and feasible and shows sufficient promise of efficacy to justify an adequately powered RCT. D 2003 Elsevier B.V. All rights reserved. Keywords: Older people; Depression; Antidepressants; Adherence; Concordance; Compliance 1. Introduction Antidepressants work well in older people with response rates of 50–60% compared to 30% with placebo (Chiu, 1999). Their ‘real world’ effectiveness is however probably limited by poor patient adher- ence. A recent survey found that only 67% of older primary care patients were fully adherent; more severe symptomatology, more medication knowledge, fewer concerns about antidepressants and fewer side effects predicted full adherence (Maidment et al., 2002).A systematic review identified nine controlled trials of 0165-0327/$ - see front matter D 2003 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2003.07.004 * Corresponding author. Tel.: +44-20-7848-0735, (mobile): 07711-747489; fax: +44-20-7277-1462. E-mail address: n.higgins@iop.kcl.ac.uk (N. Higgins). www.elsevier.com/locate/jad Journal of Affective Disorders 81 (2004) 287 – 291