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Background: Depression and anxiety are common in cancer and antidepressants (AD) are efficacious treatment. The relationship between AD adherence and mortality in cancer is unclear. This study aimed to evaluate the association between adherence to AD and all-cause mortality in a population-based cohort of patients with cancer., Materials and Methods: We conducted a 4-year historical prospective cohort study including 42,075 patients with cancer who purchased AD at least once during the study period. Adherence to AD was modeled as nonadherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) adherence. We conducted multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality., Results: During 1,051,489 person-years at risk follow-up, the adjusted hazard ratios (HR) for mortality were 0.89 (95% confidence interval [CI]: 0.83-0.95), 0.77 (95% CI: 0.66-0.72), and 0.80 (95% CI: 0.76-0.85) for the poor, moderate, and good adherence groups, respectively, compared to the nonadherent group. Analysis of the entire sample and a subgroup with depression, for cancer subtypes, revealed similar patterns for breast, colon, lung, and prostate cancers, but not for melanoma patients. Multivariate predictors of premature mortality included male gender (HR 1.48 [95% CI: 1.42-1.55]), current/past smoking status (HR 1.1, [95% CI: 1.04-1.15]; P < .0001), low socioeconomic status (HR 1.1, [95% CI: 1.03-1.17]; P < .0001) and more physical comorbidities., Conclusions: The present study is the first to demonstrate that higher adherence to AD is associated with a decrease of all-cause mortality in a large nationwide cohort of cancer patients. Our data add to the pressing need to encourage adherence to AD among cancer patients., (© 2019 Wiley Periodicals, Inc.)

Methylphenidate (MPH) is a common and effective treatment for attention deficit hyperactivity disorder (ADHD), but little is known about the relationship between early childhood intake of MPH and onset of antidepressant treatment during adolescence. The study aimed to examine whether adherence to MPH during early childhood predicts the initiation of antidepressants during adolescence. This is a 12-year historical prospective nationwide cohort study of children enrolled in an integrated care system who were first prescribed MPH between the ages of 6 and 8 years (N = 6830). We tested for an association between their adherence to MPH during early childhood (as indicated by medication possession ratio from MPH onset through the age of twelve) and the likelihood of being prescribed any antidepressant during adolescence (age 13-18). As all country citizens are covered by mandatory health insurance, and full services are provided by one of the four integrated care systems, data regarding patients' diagnoses, prescriptions, and medical purchases are well documented. Logistic regression analysis indicated that those with higher adherence to MPH had a 50% higher risk (95% CI 1.16-1.93) of receiving antidepressants during adolescence when controlling for other comorbid psychiatric conditions and parental use of antidepressants. In this large-scale longitudinal study, MPH adherence during early childhood emerged as a predictor for antidepressant treatment during adolescence, which may reflect increased emotional and behavioral dysregulation in this group. The highly adherent patients are at higher risk and should be clinically monitored more closely, particularly into adolescence.

Post stroke depression is common and pervasive. In the general population, there has been some controversy that antidepressant (AD) medication is associated with premature mortality. Data is still lacking regarding the association between adherence to antidepressants (AD) and all-cause mortality. In this retrospective analysis of a population-based cohort of patients, 32,361 post-stroke patients who purchased at least one AD were followed for all-cause mortality over 4-years. Adherence to AD was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n=8619), poor (20-50%, n=5108), moderate (50-80%, n=5656), and good (>80%, n=12,978) adherence. Multivariable survival analyses, adjusted for demographic and clinical variables including physical comorbidities known to influence mortality, were conducted. Unadjusted mortality rates were 16.5%, 20.2%, 22.2% and 23.7% in those classified as non-adherent, poor, moderate and good adherence respectively (χ 2 =174.6, p<0.0001). In the adjusted model, the non-adherent and poor adherence groups had significantly increased mortality Hazard Ratios (HR) of 1.25 (95% CI: 1.17-1.33) and 1.17 (95% CI: 1.09-1.26) respectively compared to the good adherence group. This nationally representative data suggests that poor adherence to AD is associated with increased all-cause mortality among people who had a stroke. Given our findings and the high prevalence of anxiety and depression along with AD effectiveness, efforts to promote AD adherence in this population may be warranted in clinical practice., (Copyright © 2017 Elsevier B.V. and ECNP. All rights reserved.)

Introduction: The purpose of this study was to evaluate the relationship between adherence to antidepressants (AD) and all-cause mortality in a population-based cohort of patients with Parkinson's Disease (PD)., Methods: From a database of more than 4 million people, 8553 patients with PD who purchased an AD at least once between the years 2008-2011 were retrospectively followed for all-cause mortality over 4-years. Adherence was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n = 1566), poor (20%-50%, n = 1184), moderate (50%-80%, n = 1584), and good (>80%, n = 4219) adherence. Multivariable survival analyses adjusted for demographic and clinical variables including physical comorbidities known to influence mortality were conducted, however there was no adjustment for other psychiatric disorders and medications., Results: Unadjusted mortality rates were 20.4%, 25.1%, 23.4% and 25.6% in those classified as non-adherent, poor, moderate and good adherence respectively (χ2 = 18.45, p < 0.0001). The non-adherent and poor adherence groups had significantly increased adjusted mortality hazard ratios (HR) of 1.43 (CI: 1.26-1.62) and 1.26 (CI: 1.1-1.44) respectively compared to the good adherence group. Using the same model, the adjusted HR for death among males was 1.49 [95% CI: 1.36-1.62] compared to females. People with PD and Charslon's Comorbidity Index score of 3-4 (HR 1.3, P < 0.001) and 5+ (HR 1.78, P < 0.001) were more likely to die than those with 0-2 comorbidities., Conclusions: Our findings suggest that poor adherence to AD is associated with increased all-cause mortality in people with PD. Given the high prevalence of depression and AD effectiveness, efforts to promote adherence should be prioritized in clinical practice., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Despite the growing use of antidepressants and the potential grave consequences of inadequate treatment, little is known about the impact of adherence to antidepressant treatment on mortality in the general population. The objective of this study was to evaluate the association between adherence to antidepressants and all-cause mortality in a population-based cohort., Methods: Data were extracted from the electronic medical record database of the largest health provider in Israel (53% of the nation's population) on a total of 251,745 patients aged 40 years and above who filled an antidepressant prescription at least once between 2008 and 2011. The main outcome measure was all-cause mortality during the study period. Adherence was measured as a continuous variable representing possession ratio (duration of filled antidepressant divided by duration of prescribed antidepressant). A polynomial model of proportional hazard Cox regression for multivariable survival analysis was used, adjusting for demographic and clinical variables that affect mortality., Results: The association between adherence and the hazard ratio (HR) for mortality follows a quadratic model in which the lowest HR (0.66 [95% CI, 0.64-0.69]) is at a level of 60% adherence in respect to nonadherence., Conclusions: Adherence to antidepressants is significantly associated with a corresponding decrease in the risk of mortality, controlling for relevant covariates. Physicians from all disciplines should actively improve their patients' adherence to antidepressants since their persistent use is associated with increased survival., (© Copyright 2016 Physicians Postgraduate Press, Inc.)

Introduction: Impaired adherence is common among patients using antidepressant drugs (ADs). However, few studies investigated the role of age and gender in adherence to AD and finding conflict., Objective: This study aimed to determine how gender and age impact adherence to AD in a large-scale cohort., Methods: We conducted a historical cohort study (N = 310,994 individuals) that claimed AD prescriptions during a 4-year period. Adherence was defined as the ratio between the duration of claimed AD prescriptions and the duration of continuously prescribed AD., Results: Substantial differences in the mean adherence to AD were noted throughout the lifespan, ranging from 0.38 (first decade) to 0.63 (tenth decade). Average adherence was significantly higher for males aged 20-40 years than for females of that age, but this relationship reversed later in life (50-70 years). A regression analysis model of adherence as the dependent variable showed a significant interaction between age and gender variables (beta = 0.001, p < 0.0001)., Conclusions: This study demonstrates the effect of age and gender, and their interaction, on adherence to AD across the entire life span. The marked age- and modest, yet significant, gender-related effects should be taken into consideration when targeting impaired adherence to these commonly prescribed medications.

Background: The use of antidepressant drugs in patients with ischaemic heart disease (IHD) has been debated owing to scarcity of data and conflicting results regarding the effect of these drugs on mortality., Aims: To evaluate the association between adherence to antidepressant therapy and all-cause mortality in a population-based cohort of patients with IHD., Method: A total of 63 437 patients with IHD who purchased antidepressants at least once during the years 2008-2011 were retrospectively followed for all-cause mortality over 4 years. Adherence was measured as a ratio between claimed and prescribed durations of medication and modelled as non-adherence (<20%), poor (20-50%), moderate (50-80%) and good (>80%). We used multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality., Results: The moderate and good adherence groups had significantly reduced adjusted mortality hazard ratios of 0.83 (95% CI 0.78-0.88) and 0.86 (95% CI 0.82-0.90) respectively, compared with the non-adherence group., Conclusions: Adherence to antidepressant pharmacotherapy is associated with reduced all-cause mortality in a population-based large sample cohort of patients with IHD. Physicians and health policy decision-makers should step up their efforts to sustain and enhance these patients' adherence to their antidepressant regimen., (Royal College of Psychiatrists.)