Discontinuation of antidepressant therapy among patients with major depressive disorder

Abstract

Objective: Patients with major depressive disorder (MDD) often discontinue antidepressant therapy prematurely risking relapse, despite United Kingdom (UK) guidelines recommending therapy for up to at least six months after remission. More information is needed on the patterns of antidepressant discontinuation in UK primary care. Objectives of the study were to assess the patterns, incidence and predictors of therapy discontinuation among MDD patients initiating treatment with selective serotonin reuptake inhibitors (SSRIs). Methods: This was a retrospective cohort study using general practices registered with the General Practice Research Database (GPRD). 15,274 patients with MDD receiving a first ever prescription (index) for an SSRI between 2006-2008 were identified in GPRD. Discontinuation (including temporary gaps) and cessation of antidepressant therapy were examined over follow-up. Predictors of incidence of discontinuation in the six months after index were assessed. Results: Incidence of discontinuation of antidepressant therapy over follow-up was 80.05 per 100 person years (95% CI 78.94 -81.17). At six months after index 42% of patients had discontinued and 33% had ceased therapy altogether. Lower discontinuation of index SSRI therapy in the first six months after initiation was associated with higher age, higher body mass index (BMI), and comorbid irritable bowel syndrome. Higher discontinuation was associated with paroxetine or fluoxetine at index, and a more recent index calendar year. Conclusions: There is a significant risk of discontinuation of antidepressant therapy in the 6 months after initiation of treatment for MDD. This finding requires awareness by the general practitioner (GP) to ensure implementation of optimal treatment regimens, and minimization of therapy non-compliance among MDD patients.

Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis

“…Patients' nonadherence to their psychotropic medication was associated with some non-modifiable demographic factors such as age and gender) [28]. In three studies, patients aged 60 years and older were more likely to be non-adherent to their medication [23,55,58]. Nevertheless, one study [60] reported that young age (less than 34 years) patients were also more likely to have medication non-adherence.…”

Explaining the variation between practices in the duration of new antidepressant treatment: a database cohort study in primary care

“…14 This study was designed after the original database queries that examined individual patient variation, however, the practicelevel data supplied by PCCIUR included an appropriate range of measures for analysis. The dataset was not restricted to treatment of individuals with a coded diagnosis of depression, as others have, 2,15 or to a depression-indicative Quality and Outcomes Framework (QOF) depression severity measure score. 15 As such, this study may be more broadly representative of individuals receiving antidepressant prescriptions.…”

“…The dataset was not restricted to treatment of individuals with a coded diagnosis of depression, as others have, 2,15 or to a depression-indicative Quality and Outcomes Framework (QOF) depression severity measure score. 15 As such, this study may be more broadly representative of individuals receiving antidepressant prescriptions. For example, only 29% of patients in the current study had a depression diagnostic code recorded.…”

“…For example, only 29% of patients in the current study had a depression diagnostic code recorded. Using the General Practice Research Database, Davé et al 15 found that 16% of individuals identified with a first-time SSRI prescription within their study period had either a major depressive disorder Read Code entry or a depression indicative score on a validated measure. By excluding individuals without a diagnostic code or depression score, such samples may be unrepresentative of individuals receiving antidepressants for depression in primary care.…”

Clinical characteristics associated with therapeutic nonadherence of the patients with major depressive disorder: A report on the National Survey on Symptomatology of Depression in China

“…[3][4][5] Although most clinical guidelines recommend antidepressants be continued for at least 6 months after symptom remission, 6 approximately one-third of patients discontinued the use of antidepressant medication within the first month of treatment, and about 40% quitted them by the sixth month of treatment. 7 Some patients may feel better and think they no longer need the medication, or stop their medicine because of bothersome side effects, without consulting their doctors. Premature withdrawal of treatment often led to increases relapse and recurrence rates, which were found to be high.…”