Compliance with tricyclic antidepressants: the value of four different methods of assessment

Br J Clin Pharmacol. 2000 Aug;50(2):166-71. doi: 10.1046/j.1365-2125.2000.00244.x.


Aims: To assess the advantages and disadvantages of four methods for studying compliance with antidepressants: self-report scores, tablet counts, a microprocessor (MEMS) container system and the assay of nordothiepin and dothiepin concentrations in plasma.

Methods: The techniques were used in 88 patients commencing tricyclic antidepressants in the setting of UK general practice.

Results: The MEMS system proved to be the most informative technique allowing identification of the precise time of container opening, the demonstration of 'drug holidays' and early cessation of therapy. Self-report scores (Morisky) proved a useful screening technique with a sensitivity of 72.2% and specificity of 74.1% for > or = 80% compliance. Although tablet counts were possible in 84 patients (95. 5%) they were unreliable in 19 (21.6%). Blood concentration assays proved the least acceptable method to patients and were possible in only 53 (60.2%). A ratio of nordothiepin:dothiepin > or = 1.1 claimed, by others, to identify noncompliance was only reliable when concentrations were low.

Conclusions: Both the MEMS system and self-report scores proved useful methods for identifying noncompliant patients in the setting of UK general practice. Although compliance was higher than reported in previous studies with 70 patients (79.5%) completing 6 weeks treatment, general practitioners tended to prescribe subtherapeutic doses.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antidepressive Agents, Tricyclic / blood
  • Antidepressive Agents, Tricyclic / therapeutic use*
  • Depressive Disorder / blood
  • Depressive Disorder / drug therapy*
  • Family Practice
  • Female
  • Humans
  • Male
  • Microcomputers*
  • Middle Aged
  • Patient Compliance / psychology*
  • Self Administration / psychology
  • United Kingdom / epidemiology


  • Antidepressive Agents, Tricyclic