Currently submitted to: JMIR Formative Research
Date Submitted: Sep 4, 2026
Open Peer Review Period: Nov 10, 2026 - Jan 5, 2027
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Utilizing Short Message Service (SMS) Engagement for Antidepressant Medication Management and Adherence: A Quasi-experimental Design
ABSTRACT
Background:
Major depressive disorder (MDD) contributes to impairment in daily functioning and, if untreated, can result in severe morbidity and mortality rates. Although medications are effective, adherence remains a significant challenge, with only an estimated 25-50 percent of patients adhering to their prescribed medication regimen. Text message interventions have demonstrated potential in improving medication adherence, particularly for individuals with serious mental illness, by addressing patient-specific barriers.
Objective:
This study investigates the efficacy of text message interventions in improving medication adherence by addressing common barriers faced by individuals prescribed antidepressants.
Methods:
We designed an intervention using behavioral science techniques and health communication models to increase medication adherence rates among Medicaid beneficiaries in Philadelphia who had recently been prescribed antidepressants. This intervention, delivered via SMS over six months, used natural language processing (NLP) to tailor responses to patient queries. The sample included 1,760 participants, with 320 in the intervention group and 1,440 in the control group.
Results:
The intervention showed no statistically significant difference in medication adherence between the two groups during the acute (p=0.2076) and continuation (p=0.3051) phases. However, greater engagement with SMS messages was significantly associated with increased adherence (p<0.001). The most common barriers to adherence included forgetfulness and perceived medication inefficacy. Overall, 70% of participants found the intervention helpful, although satisfaction was not significantly correlated with adherence. These findings suggest that while SMS interventions alone may not lead to significant improvements in adherence, increased patient engagement with the messages plays a critical role in supporting medication adherence.
Conclusions:
Although further research is needed, text message interventions appear to be a promising tool for identifying and addressing barriers to medication adherence in patients with MDD.
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