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Research Letter
September 23, 2020

Effect of Escalating and Deescalating Financial Incentives vs Usual Care to Improve Antidepressant Adherence: A Pilot Randomized Clinical Trial

Author Affiliations
  • 1University of Pennsylvania School of Social Policy and Practice, Philadelphia
  • 2Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Department of Psychiatry, Columbia University, New York, New York
JAMA Psychiatry. 2021;78(2):222-224. doi:10.1001/jamapsychiatry.2020.3000

Although antidepressant medications are efficacious for depression,1 nonadherence frequently undermines their effectiveness.2 Antidepressants have a delayed onset and therefore do not offer prompt symptom relief that would support adherence.3 It is unknown whether financial incentives, which encourage adherence to some4 but not other5 health behaviors, improve antidepressant adherence for depression. This randomized clinical trial (ClinicalTrials.gov Identifier: NCT03441399) compared 2 behavioral economics–based financial incentives for daily antidepressant adherence: (1) escalating incentives that leverage loss aversion because patients who initiate treatment face ever-greater lost opportunities if they discontinue medication use and (2) deescalating incentives that leverage a tendency to overweigh present benefits by providing larger rewards to overcome initial inertia concerning treatment initiation.

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