This systematic review examines the economic and human costs of depression and 
the potential savings associated with improvement in patient adherence to 
treatment with antidepressants through the use of enhanced-care programs. A 
MEDLINE search was conducted for papers published on the health economics and 
costs of depression and compliance, adherence, and persistence. Compliance data 
collected through the online antidepressant compliance support website iCAN 
(www.ican.co.uk) were compared with data for patients with depression from the 
IMS Disease Analyzer UK database. Depression frequently causes unemployment, 
absenteeism, and presenteeism, which results in significantly reduced 
productivity. Indirect costs of depression accounted for more than $50 billion, 
whereas direct costs resulted in expenditure of $26 billion, in the US in 2000. 
Improving patients' compliance with their antidepressant medication results in 
improved outcomes and prolongs remission from depression, increasing work 
productivity, and thus reducing overall costs. The implementation of remote 
enhanced-care programs may improve compliance and reduce overall costs. Novel 
methods for delivering enhanced-care programs to assist in maintaining 
compliance have the potential to further reduce costs and should be a focus of 
future research. In conclusion, depression is a common disorder with a high 
economic impact. Enhanced-care programs may lower costs associated with 
depression and improve patients' lives.