Noncompliance in chronic depression: Assessment of serum antidepressant determination with the enzyme-immunoassay method

To determine whether chronically depressed patients are compliant with treatment, we measured serum triyclic levels in 43 outpatient veterans treated with tricyclic antidepressants (TCAs) with dosages 75 mg/day or higher. Eighteen patients had a diagnosis of major depression; thirteen, dysthymia; five, bipolar depressed; and seven, schizoaffective disorder, depressed type. With no prior warning, blood samples were collected for homogeneous enzyme-multiplied immunoassay test (EMIT) tricyclic serum level determination. Also, short MMPI, Hamilton-D, BPRS, 1-year pharmacy computerized profile, and a comprehensive list of side effects and comorbidity were obtained. Fifteen patients (35%) had nondetectable serum levels. Noncompliant patients (those with nondetectable levels) had significantly fewer refills during the year, and tended to have higher F scales on their MMPIs. Forty-five percent of patients who were prescribed amitriptyline or imipramine were noncompliant, whereas only 1 of 12 patients prescribed desipramine was noncompliant. Of the 28 compliant patients, 22 were alcohol abstinent and 21 had a better understanding of their medications. All five patients who have diabetes mellitus were compliant. No significant differences were found in the other demographic or pyschometric measurements. EMIT methodology did not appear to be sensitive enough for patients receiving 50 mg/day or less of TCA. Noncompliance with the chronic use of TCAs appears to be quite frequent, occurring in the management of the depressed male veteran; therefore, its assessment becomes a significant part of optimal patient management.