Current treatments used in clinical practice for major depressive disorder and treatment resistant depression in England: A retrospective database study

Denee, Tom; Kerr, Cicely; Ming, Timothy; Wood, Robert; Tritton, Theo; Middleton-Dalby, Chloe; Massey, Olivia; Desai, Mitesh

doi:10.1016/j.jpsychires.2021.05.026

Cited by 9 publications

(10 citation statements)

References 16 publications

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“… 24 , 25 Although many treatment options are currently available for treatment-resistant depression, 20 , 21 studies suggest that these therapies may lack consistent long-term efficacy, 26 and approximately one-third of patients with major depressive disorder do not respond significantly to first-line treatment. 27 Even when two antidepressants with different pharmacological mechanisms are combined, treatment in 10% to 30% of patients is ineffective. 28 As early as 2003, Daly et al 29 evaluated the efficacy of intranasal esketamine and placebo in treating treatment-resistant depression and then re-evaluated clinical trials at the international level to verify the safety and efficacy of the experiment.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Esketamine Combined with Antidepressants for Treatment-Resistant Depression: A Meta-Analysis

Liu¹,

Zhang²,

Liang³

et al. 2022

NDT

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Objective To evaluate the efficacy and safety of esketamine + antidepressant in treatment-resistant depression. Methods We searched PubMed, Web of Science, Embase, CNKI, and Wanfang databases to obtain published information on esketamine + antidepressant from inception to July 2022. We searched for randomized controlled studies on the treatment of depression with a double-blind induction phase. Outcome indicators included changes in Montgomery-Asberg Depression Rating Scale (MADRS) scores before and after treatment, effective response rate, remission rate, and changes in self-rating depression scale (SDS). We analyzed data using Review Manager 5.4 and assessed the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis. Results A total of seven articles were included, including 701 patients in the esketamine + antidepressant group and 551 in the placebo group. Meta-analysis results showed that esketamine + antidepressant could improve the MADRS score in patients with treatment-resistant depression (MD = −2.68, 95% CI −3.98 to −1.37, P < 0.0001), SDS (MD = −2.9, 95% CI −4.01 to −1.79, P < 0.00001), response rate at the end of the double-blind induction period (RR = 1.28, 95% CI 1.12 to 1.46, P = 0.0002), remission rate at the end of the double-blind induction period (RR = 1.39, 95% CI 1.18 to 1.63, P < 0.0001), Five-Dimensional Health Scale (EQ-5D-5L) (MD = 0.05, 95% CI 0.02 to 0.08, P = 0.00009), Visual Analogue Scale of Health Status (EQ-VAS) (MD = 5.54, 95% CI 2.37 to 8.71, P = 0.0006). Conclusion Esketamine + antidepressant has an obvious curative effect in treatment-resistant depression and can rapidly improve depression in patients, quality of life and satisfaction, but minor adverse reactions can occur.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Esketamine Combined with Antidepressants for Treatment-Resistant Depression: A Meta-Analysis

Liu¹,

Zhang²,

Liang³

et al. 2022

NDT

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“…22.0) months and 59.1 (s.d. 16.0) months in the MDD and TRD groups, respectively. The mean duration of antidepressant treatment during the study period was 28.9 (s.d.…”

Section: Prescribing Datamentioning

confidence: 92%

Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study

Pappa,

Shah,

Young

et al. 2024

BJPsych open

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Background Despite the availability of effective therapies, many patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD). Aims To evaluate and compare prescribing patterns, contact with specialist services and treatment outcomes in patients with MDD and TRD. Method This was a retrospective analysis of linked primary and secondary care National Health Service data in the north-west London Discover-NOW data-set. Eligible patients were adults who had diagnostic codes for depression and had been prescribed at least one antidepressant between 2015 and 2020. Results A total of 110 406 patients were included, comprising 101 333 (92%) with MDD and 9073 (8%) with TRD. Patients with TRD had significantly higher risks of suicidal behaviour and comorbidities such as anxiety, asthma, and alcohol or substance misuse (all P < 0.0001). Citalopram, sertraline, fluoxetine and mirtazapine accounted for 83% of MDD and 71% of TRD prescriptions. Use of antidepressant switching (1% MDD, 7% TRD) and combination therapy (1%, 5%) was rare, whereas augmentation occurred more frequently in the TRD group (4%, 35%). Remission was recorded in 42 348 (42%) patients with MDD and 1188 (13%) with TRD (P < 0.0001), whereas relapse was seen in 20 970 (21%) and 4923 (54%), respectively (P < 0.0001). Mean times from diagnosis to first contact with mental health services were 38.9 (s.d. 33.6) months for MDD and 41.5 (s.d. 32.0) months for TRD (P < 0.0001). Conclusions There appears to be a considerable difference between treatment guidelines for depression and TRD and the reality of clinical practice. Long-term treatment with single antidepressants, poor remission, and high relapse rates among patients in primary care highlight the need to optimise treatment pathways and access to newer therapies.

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“…Including: individuals whose first recorded antidepressant prescription was monotherapy with a common first-line antidepressant (citalopram, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, venlafaxine); we limited our inclusion criteria to these antidepressants as they are the most commonly prescribed antidepressants for the initial treatment of depression in the UK. 21 Furthermore, as the clinical indication for prescription of antidepressants is not recorded in CPRD data we could not be confident that other antidepressants were being prescribed to treat depression – particularly those commonly prescribed for diabetic neuropathic pain, such as duloxetine. Excluding: individuals with <6 months of antidepressant-free data before the date of their first antidepressant prescription, to ensure that we were identifying incident (new-onset) prescribing; individuals whose first recorded antidepressant was an agent not listed in the inclusion criteria above, as these are uncommonly prescribed or used for other non-mental health conditions such as diabetic neuropathic pain.…”

Section: Methodsmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Association between polypharmacy and depression relapse in individuals with comorbid depression and type 2 diabetes: a UK electronic health record study

et al. 2022

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Background Individuals with physical comorbidities and polypharmacy may be at higher risk of depression relapse, however, they are not included in the ‘high risk of relapse’ group for whom longer antidepressant treatment durations are recommended. Aims In individuals with comorbid depression and type 2 diabetes (T2DM), we aimed to investigate the association and interaction between depression relapse and (a) polypharmacy, (b) previous duration of antidepressant treatment. Method This was a cohort study using primary care data from the UK Clinical Practice Research Datalink (CPRD) from years 2000 to 2018. We used Cox regression models with penalised B-splines to describe the association between restarting antidepressants and our two exposures. Results We identified 48 001 individuals with comorbid depression and T2DM, who started and discontinued antidepressant treatment during follow-up. Within 1 year of antidepressant discontinuation, 35% of participants restarted treatment indicating depression relapse. As polypharmacy increased, the rate of restarting antidepressants increased until a maximum of 18 concurrent medications, where individuals were more than twice as likely to restart antidepressants (hazard ratio (HR) = 2.15, 95% CI 1.32–3.51). As the duration of previous antidepressant treatment increased, the rate of restarting antidepressants increased – individuals with a previous duration of ≥25 months were more than twice as likely to restart antidepressants than those who previously discontinued in <7 months (HR = 2.36, 95% CI 2.25–2.48). We found no interaction between polypharmacy and previous antidepressant duration. Conclusions Polypharmacy and longer durations of previous antidepressant treatment may be associated with depression relapse following the discontinuation of antidepressant treatment.

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Current treatments used in clinical practice for major depressive disorder and treatment resistant depression in England: A retrospective database study

Cited by 9 publications

References 16 publications

Efficacy and Safety of Esketamine Combined with Antidepressants for Treatment-Resistant Depression: A Meta-Analysis

Efficacy and Safety of Esketamine Combined with Antidepressants for Treatment-Resistant Depression: A Meta-Analysis

Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study

Association between polypharmacy and depression relapse in individuals with comorbid depression and type 2 diabetes: a UK electronic health record study

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