Concordance therapy: an intervention to help older people take antidepressants

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.