Pharmaceutical Care and Smartphone Applications in Major Depressive Disorder: Effects on Medication Adherence

Failure to adhere to prescribed medications can result in numerous adverse clinical outcomes, such as elevated chances of relapse and disease recurrence. Through the delivery of personalized, face-to-face pharmaceutical care guidance, pharmacists have a vital role in fostering better medication adherence. In contemporary society, smartphones are among the most prevalent modes of communication. Therefore, incorporating a dedicated smartphone application for managing depression represents a promising approach to optimizing patient results. To determine if targeted counseling for depression paired with a specialized smartphone application can boost medication adherence in individuals recently diagnosed with major depressive disorder (MDD). This was a prospective, randomized pilot trial involving patients with newly identified major depressive disorder. Participants were allocated randomly to the intervention or standard care arms in a 1:1 ratio. The intervention arm received face-to-face pharmaceutical care guidance combined with training on a depression-focused smartphone application, while the standard care arm was provided with conventional pharmaceutical guidance and a basic chatbot. Medication adherence, the main endpoint, was assessed via the Medication Adherence Rating Scale (MARS) and pill count percentage (PC) during the one-month follow-up visit. As a secondary endpoint, the Patient Health Questionnaire-9 (PHQ-9) was employed to evaluate changes in depressive symptomatology. A total of 36 individuals finished the trial (18 in each arm). The mean participant age was 29.81 years, and 65.38% were women. Both arms exhibited comparable baseline features, including initial PHQ-9 values. The intervention arm recorded a mean MARS score of 7.0 (IQR=5), surpassing the standard care arm's mean of 4.5 (IQR=7; p-value=0.04). Pill count percentage was higher in the intervention arm at 81.75 (IQR=33.33) compared to 69.95 (IQR=78.57) in the standard care arm (p-value=0.10). The average change in PHQ-9 scores across visits showed a difference of -1.44 [-2.61 to -0.28] favoring the intervention arm (p-value=0.02). The findings indicate that individuals newly diagnosed with major depression who were given specialized pharmaceutical guidance for depression alongside a smartphone application exhibited enhanced medication adherence. Moreover, there was a notable amelioration in general depressive symptomatology.