Antidepressant retention and adherence among Latinx outpatients with major depressive disorder: The effect of a novel motivational interviewing-consistent approach to pharmacotherapy

Roberto Lewis-Fernández; Peter Lam; Dolly John; Ivan Balán; Hanga Galfalvy; McKenzie Quinn; Francesca Reilly; Carlos Blanco; Naihua Duan; Melissa Rosario; Arturo Sánchez-Lacay; Eve Leeman

doi:10.1016/j.jad.2026.121490

Antidepressant retention and adherence among Latinx outpatients with major depressive disorder: The effect of a novel motivational interviewing-consistent approach to pharmacotherapy

J Affect Disord. 2026 Feb 26:121490. doi: 10.1016/j.jad.2026.121490. Online ahead of print.

Authors

Affiliations

¹ New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 630 West 168(th) Street, New York, NY, 10032, United States of America. Electronic address: roberto.lewis@nyspi.columbia.edu.
² New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, United States of America.
³ New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 630 West 168(th) Street, New York, NY, 10032, United States of America.
⁴ Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 630 West 168(th) Street, New York, NY, 10032, United States of America; Department of Biostatistics, Columbia University, 722 West 168th Street, New York, NY, 10032, United States of America; Mental Health Data Science Division, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, United States of America.
⁵ Department of Biostatistics, Columbia University, 722 West 168th Street, New York, NY, 10032, United States of America.
⁶ Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 630 West 168(th) Street, New York, NY, 10032, United States of America.

PMID: 41763323
DOI: 10.1016/j.jad.2026.121490

Abstract

Patient disengagement from Major Depressive Disorder (MDD) pharmacotherapy is extensive, particularly among individuals who are Black, Indigenous, and People of Color. Based on motivational interviewing, motivational pharmacotherapy (MPT) was developed to promote engagement in psycho-pharmacotherapy by fostering communication and reducing treatment-related ambivalence. A 36-week antidepressant RCT of MPT vs. standard pharmacotherapy was conducted with 195 Latinx outpatients with at-least-moderately-severe MDD using independent adherence and retention assessments, a standardized medication algorithm, and matched provider characteristics. Retention was compared across arms using parametric and nonparametric tests as appropriate. Electronic caps helped assess medication adherence; independent evaluators assessed symptom response, disability, and quality of life. Moderation by prior antidepressant treatment adequacy was examined. MPT reduced early medication discontinuation in the first month (RR = 0.47; 95%CI:0.25, 0.90) and increased treatment completion/late discontinuation in weeks 32-36 (RR = 1.19; 95%CI:1.003, 1.41) but showed no significant effect on retention over the 36-week period. Treatment discontinuation was significantly decreased among participants without prior antidepressant history (HR = 0.56; 95%CI:0.36, 0.88) but increased at the trend level (HR = 2.33; 95%CI:0.94, 5.82) among those with adequate history. Effects on adherence, continuous MDD symptom score, disability, and quality of life were nonsignificant but there was a significant effect on MDD remission. In conclusion, MPT particularly reduced premature treatment discontinuation early in treatment and among participants without prior antidepressant experience, suggesting impact on initial treatment concerns such as ambivalence about starting medication, fears of early adverse effects, or clinician mistrust, especially among treatment-naïve individuals. Overly manualizing MPT may inadvertently hinder tailoring to individuals with greater medication experience.

Keywords: Antidepressive agents; Depressive disorder; Major; Medication adherence; Motivational interviewing; Patient retention; Randomized controlled trial.