Large increases in out-of-pocket costs for psychotropic drugs may lead to unintended consequences, including reduced adherence to antidepressant treatment regimens and greater overall health care costs due to substitution of more expensive medical services for prescription drugs. I use individual health insurance claims and benefit data from 1997 to 2004 to estimate the effect of changes in cost-sharing for antidepressants on adherence to antidepressant therapy and depression-related inpatient, outpatient, and prescription drug expenditures. I find that higher levels of cost-sharing reduce antidepressant adherence only modestly and there are no significant substitutions between antidepressants and depression-related inpatient or outpatient care. Additionally, I do not find that increased expenditures on antidepressants are offset by reductions in other medical care spending. My results suggest that pharmacy cost containment strategies are not as effective in controlling psychotropic drug expenditures as other categories of prescription drugs, and may have a greater bearing on indirect costs, such as reduced workplace productivity and absenteeism, than direct medical costs.