Scoping review links multifaceted pharmacist interventions with better antidepressant adherence

A scoping review of 18 studies found that pharmacist-led interventions generally improved adherence to antidepressant medication, with the strongest results reported for multifaceted programs combining education, behavioral support and sustained follow-up. The review also identified a major evidence gap: none of the included studies explicitly designed its intervention to be culturally tailored.

The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the Joanna Briggs Institute framework. Its protocol was prospectively registered on the Open Science Framework. Two reviewers independently screened titles and abstracts and assessed eligible full texts, resolving disagreements through discussion or consultation with a third reviewer. Data extraction was conducted by the first author and cross-verified by two other reviewers.

The search covered PubMed, Scopus and Google Scholar, with additional searches of ProQuest Dissertations & Theses, OpenGrey, Open Science Framework Registries, preprint servers and Indonesian university repositories. Eligible studies were published in English or Indonesian between January 2005 and August 2025 and included adults aged 18 years or older with depression. They had to evaluate pharmacist-led or pharmacist-involved interventions that assessed antidepressant adherence or persistence, and could use quantitative, qualitative or mixed-methods designs.

The 18 included studies were conducted in psychiatric hospitals, community pharmacies and outpatient clinics across Asia, Europe, the Middle East, Africa and Australia. Most were randomized controlled trials, and follow-up periods ranged from four to 48 weeks. Interventions were grouped into educational and monitoring approaches, counseling-based approaches, collaborative care models, adherence support or coaching, and digitally assisted interventions. Most were delivered face to face, sometimes with telephone or digital follow-up.

Twelve of the 18 studies reported significant improvements in antidepressant adherence, five reported no significant differences, and one observational study had no comparator. Multicomponent programs combining education, behavioral strategies, motivational support and continued follow-up were associated with better adherence outcomes than single-component approaches. Studies also generally associated pharmacist-led interventions with lower dropout rates than usual care, although the scoping design did not calculate a pooled effect.

The included programs used varied measures of adherence, including self-reported scales, pill counts, refill records, medication possession ratio and proportion of days covered. Examples of significant improvements were reported for a German intervention combining face-to-face sessions, motivational interviewing and leaflets; a Japanese program involving six cognitive behavioral therapy-based counseling sessions; and a US collaborative telepsychiatry model delivered by a multidisciplinary team. These studies differed in design, intervention intensity, assessment methods and follow-up, so their results cannot be treated as directly comparable estimates.

Implementation barriers extended beyond the content of the interventions. Heavy workloads, limited consultation time, workforce shortages and insufficient pharmacist training in mental health and communication constrained delivery. Patient-level barriers included stigma, negative beliefs about medication and limited social support. Studies also reported challenges involving telecommunication infrastructure, privacy and documentation, financial sustainability, team coordination, digital literacy and demands of follow-up counseling.

None of the 18 studies explicitly incorporated culturally tailored intervention strategies, even though several recognized family support, psychological motivation and sociocultural beliefs as relevant to adherence. The authors regarded this as particularly important for Indonesia, where the 2018 National Basic Health Research reported a depression prevalence of 6.1% among people aged 15 years or older. They also cited Indonesian research in which 76.2% of young adults with depression had low adherence, associated with poor mental health literacy, adverse effects, limited social support and insurance barriers.

The review’s conclusions are bounded by its descriptive methodology. Differences in study designs, adherence metrics and follow-up limited comparisons and long-term inference. The predominance of English-language studies and studies from high-income countries may introduce publication bias, while the absence of a formal risk-of-bias assessment constrained methodological appraisal. The authors said future studies should evaluate culturally responsive, family-centered interventions, use more standardized adherence measures and longer follow-up, and examine scalability and cost-effectiveness through pragmatic designs. They also called for stronger pharmacist training, clearer professional roles, adequate consultation capacity, interdisciplinary collaboration and appropriate digital support.

Subject of Research: Scoping review of pharmacist-led interventions supporting antidepressant medication adherence in adults with depression

Article Title: Pharmacist intervention to improve medication adherence in patients with depressive disorder: A scoping review

Article References: Ariyani, H., Wiedyaningsih, C., Prabandari, R. A. Y. S., & Idaiani, S. (2026). Pharmacist intervention to improve medication adherence in patients with depressive disorder: A scoping review. Pharmacia, 73, Article e178613. https://doi.org/10.3897/pharmacia.73.e178613

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e178613

Keywords: pharmacist-led care, antidepressant adherence, depression, scoping review, medication counseling, behavioral support, treatment persistence, implementation barriers, cultural adaptation, digital health, Pharmacist, intervention