Concordance Therapy and Medication AdherenceInterventions to improve antidepressant adherence in primary care settings that are effective, low-cost andeasily disseminated are needed. To examine the utility of such interventions, several considerations requireattention. First, differences in individual patient beliefs may significantly influence antidepressant adherenceand will likely require individualized attention. Adherence may differ depending on whether the medication isbeing used acutely or in continuation treatment. Moreover, the adherence intervention may need to differdepending on whether the patient is in acute or continuation treatment.In addition, medical comorbidity is common among depressed primary care patients, and depressionmay have an adverse impact on adherence to medical regimens. In fact, depressive symptoms have beenlinked to inadequate treatment adherence in several chronic diseases, including diabetes mellitus, coronaryartery disease, asthma, and hypertension.We propose to evaluate the effectiveness of a single modality adherence intervention (ConcordanceTherapy), delivered by primary care nurses, in a racially diverse sample of primary care patients withunipolar depression and comorbid diabetes mellitus or hypertension. We will also evaluate whetherimprovement in adherence to antidepressant treatment is associated with improvement in adherence to oralmedication regimen for diabetes or hypertension. The intervention will be uniquely targeted to addressidentified and specific barriers to adherence in acute depression treatment, as well as specific impedimentsto adherence during continuation depression treatment. Specifically we plan to: 1 evaluate the effectivenessof Concordance Therapy to improve antidepressant adherence in primary care patients with unipolardepression and comorbid diabetes mellitus, or hypertension; and 2) To evaluate the impact of changes inantidepressant adherence on participants' adherence to oral medication regimen for diabetes orhypertension.
