Better Adherence, Better Outcome: Differences in Depressed Participants’ Adherence to Elements of the Therapeutic Lifestyle Change Protocol

Depression is a devastating illness. It is the leading cause of disability worldwide, and it afflicts 6.7% of Americans every year ((World Health Organization [WHO], 2012; National Institutes of Mental Health [NIMH], 2014). Worse, there is considerable evidence that traditional therapy—particularly drug therapy—is not particularly effective (Whitaker, 2010; Krystal, Sanacora, & Duman, 2013). The data from the STAR*D trials conducted by NIMH demonstrated that, among 4,000 depressed patients given standard antidepressant drugs, only slightly more than one quarter of these patients achieved remission after 3 months (Krystal et al., 2013). Researchers have begun investigating new avenues for treating depression, in large part because of the inadequacy of standard antidepressant treatment. Omega-3 supplementation, bright light exposure, and exercise all have a positive impact on depressive symptoms (Grosso et al., 2014; Even, Schroder, Friedman, & Rouillon, 2008; Josefsson, Lindwall, & Archer, 2014). The Therapeutic Lifestyle Change (TLC) program combines these approaches, finding that they are even more effective together than separately (Ilardi et al., 2012). A major problem for the success of any treatment is participant adherence (Centers for Disease Control [CDC], 2013). The CDC estimates that roughly 50% of medications are not continued as prescribed (2013), and others studies suggest that adherence to non-medication regimes—such as exercise plans—is even worse (Robison & Rogers, 1994; Findorff, Wyman, & Gross, 2009). It seems that not following the doctor’s orders really makes a difference too. Research shows that adherence really matters for determining Q&A