Digital support for antidepressant pharmacotherapy in adults with depressive disorders: a systematic review of effectiveness, safety, and care-delivery models

Introduction. Initiation and adjustment of antidepressant therapy require regular assessment of treatment adherence, medication tolerability, and changes in depressive symptoms. Digital communication channels, mobile applications, telemedicine-based models, and clinical decision support systems may facilitate such monitoring; however, their effectiveness largely depends on personalized feedback and specialist involvement. Aim: To summarize the evidence on the effectiveness, safety, and organizational models of digital pharmaceutical support for adults with depressive disorders. A systematic review was conducted in accordance with the PRISMA 2020 guidelines. The qualitative synthesis included 8 randomized controlled trials, while an additional 6 systematic reviews and meta-analyses were analyzed to contextualize the findings. The interventions included remote multidisciplinary care, secure messaging, mobile applications, systems for personalized antidepressant selection, and physician-prescribed digital therapeutics. The most consistent findings concerned improved adherence and continuity of treatment. Specialist-supported secure messaging increased the proportion of patients continuing treatment for more than 3 months from 61% to 81%. The PETRUSHKA system reduced treatment discontinuation from 27% to 17%, including discontinuation due to adverse reactions from 16% to 9%. Automated messaging without specialist involvement did not produce a significant effect. The effects of pharmacogenomics-guided systems and digital therapeutics on clinical response and remission were modest and heterogeneous. No Russian studies meeting the eligibility criteria were identified. Conclusion. A hybrid model appears to be the most appropriate approach: the digital service monitors medication use, symptoms, and adverse reactions; a healthcare professional provides personalized feedback and facilitates patient referral; and the treating physician makes decisions regarding treatment adjustment. Russian randomized controlled trials are required to evaluate the effectiveness of this model.