Does Mental Health, Depression Impact Medication Adherence?

New research out of the University of Pittsburgh School of Medicine has found a link between a mental health diagnosis of depression and medication adherence, underscoring the need for better depression screening during certain treatments, the researchers said.

Particularly, the researchers found that individuals with depression who also completed percutaneous coronary intervention (PCI), a common procedure to clear clogged arteries, had lower medication adherence rates than those receiving PCI without a diagnosis of depression.

Individuals receiving PCI have to manage a number of medications after the procedure: beta-blockers, antiplatelets, and statins. These medications reduce the risk of heart attack or another cardiovascular event, the researchers said.

But medication adherence can be elusive for a lot of chronic disease patients, with the skyrocketing cost of medications and other social determinants of health impacting patient access to prescriptions.

This latest study adds to that list, finding that other clinical diagnoses like depression can also affect medication adherence after PCI. This finding is particularly salient considering the adverse cardiovascular health many depression patients experience. People with depression have three times the risk of health problems or death after a heart attack than those without depression, the researchers said.

“It is well-appreciated that depression carries adverse cardiovascular risk. We wanted to understand better why that is the case,” Jared W. Magnani, MD, MSc, UPMC cardiologist and associate professor of medicine at Pitt, stated publicly.

After combing through health records and claims data for 124,000 people with and without depression who also underwent PCI, the researchers found stark differences in medication adherence.

“We found that 10%-20% of individuals with depression were less likely to take their medicine after PCI – which is significant – because this group is at a higher risk for serious complications or dying from a heart attack,” Magnani said.

Although the researchers did not assess the reasons behind lower medication adherence among depression patients, they did indicate that the nature of the illness could be keeping some from filling their prescriptions.

“Depression is associated with autonomic dysfunction, hormonal dysregulation, hypercoagulability, and endothelial inflammation, all of which may augment cardiovascular risk,” Magnani and his team wrote in the study’s discussion section. “Individuals with depression have increased likelihood of an array of behavioral changes.”

“However, we recognize that behavioral risk factors for cardiovascular disease are not reliably characterized by an administrative database,” they added as a caveat.

Simply knowing that a diagnosis of depression could be linked to lower medication adherence following PCI is helpful, with the researchers urging for better depression screening when treating patients with PCI.

“We provide critical and sometimes lifesaving therapies to our patients with heart disease, and then prescribe therapies which we know can help them,” Magnani said in the statement. “If depression challenges or reduces their ability to adhere to those medications, then it is essential to address depression as part of cardiovascular care and treatment. Our team considers our findings an invitation to develop strategies to recognize depression as part of cardiovascular care.”

Being aware of the link between depression and cardiovascular disease is essential, according to Study co-author Bruce Rollman, MD, UPMC endowed chair and professor of medicine at Pitt. Many with cardiovascular disease have or will develop depression, while people with depression have a four-fold risk for developing cardiovascular disease.

“This study may help explain why cardiac patients with co-morbid depression tend to have higher rates of hospital readmissions and mortality than non-depressed cardiac patients,” Rollman said in the press release. “It also points to the need for organized health systems, such as UPMC, to routinely screen for and treat depression to maximize patients’ potential benefits from undergoing these high-cost cardiac procedures.”