Epidemiology of pharmaceutically treated depression and treatment resistant depression in South Korea

Abstract

Background The epidemiology of pharmaceutically treated depression (PTD) and treatment resistant depression (TRD) is largely unknown in South Korea. The aim of this study was to develop a greater understanding of the characteristics of PTD and TRD in nearly the entire adult population in South Korea using the Health Insurance Review and Assessment Service (HIRA). Method Diagnostic codes and prescription data for South Korean adults were extracted from the HIRA. Subjects were included in the PTD cohort if they received at least one prescription for antidepressants and were diagnosed with depression. TRD was defined as PTD having two or more regimen failures of antidepressants or antipsychotics. Results In 2012, there were 41,256,396 adults in South Korea with 834,694 meeting the criteria for PTD (2.0%). Among subjects with PTD, 57% stopped treatment in less than 28 days of antidepressant supply. Tricyclic and tetracyclic antidepressants were the most frequently used antidepressants as a first-line regimen for PTD (44.3% of PTD) followed by selective serotonin reuptake inhibitors (32.1% of PTD). Results also indicated that 34,812 subjects developed TRD (4.2% of PTD). Median PTD and TRD durations were 28 and 623 days respectively. Proportions of psychiatric and non-psychiatric comorbidities were higher in TRD cases than in PTD cases that were not treatment resistant. Conclusions Despite a small proportion of patients with TRD, the prolonged duration of illness and higher comorbidity implies the need for better treatment.

Clinical characteristics of treatment-resistant depression in adults in Hungary: Real-world evidence from a 7-year-long retrospective data analysis

“…In terms of psychiatric comorbidities, the TRD population was observed to have an increased risk of comorbid “Neurotic, stress-related and somatoform disorders” (ICD-10 F40–F48; see S6 Table in S2 File ) compared with the non-TRD population. This finding is in line with the results of several previous studies [ 2 , 8 , 20 , 35 , 39 , 49 , 50 , 58 ]; however, Perugi et al reported an almost identical prevalence of anxiety disorders in patients with MDD with and without TRD [ 29 ]. Conversely, Gronemann et al reported that patients with depression with comorbid anxiety had a lower risk of TRD compared with patients without comorbid anxiety, after adjustment for other measures of depression severity [ 54 ].…”

“…As depressive episodes in the context of bipolar disorder are less responsive to AD treatment compared with those in MDD, the inclusion of patients with unidentified bipolar (spectrum) disorder could potentially distort the frequency of TRD [ 19 , 59 – 61 ]. With regard to somatic comorbidities, previous studies have reported conflicting results [ 8 , 18 , 34 , 35 , 37 , 39 , 49 , 50 , 58 , 62 , 63 ]. Within this study, we detected a significantly higher risk of autoimmune diseases, thyroid gland diseases, and cardio- and cerebrovascular disorders in patients with TRD compared with the non-TRD group.…”

Antidepressant Use and the Risk of Major Adverse Cardiovascular Events in Patients Without Known Cardiovascular Disease: A Retrospective Cohort Study

“…It seems that psychiatrists might prescribe low doses of TCAs to minimize its known harmful effects on CVDs while preserving its clinical effect on depression. Kim et al reported that it is common for psychiatrists in Korea to prescribe antidepressants in doses less than the minimum effective daily dose due to their side effects ( Kim et al, 2019 ). Our results showed that TCA use was associated with an increased risk of MACEs even at its low doses, <0.5 DDD.…”

<p>Definition and Identification of Patients with Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

“…Recent estimates of TRD prevalence, extracted from insurance databases, among pharmaceutically treated depressive patients ranged from 4.2% in Korea to 20.9% in Taiwan. 10 , 11 Given the lack of standardized definition of TRD, it is not surprising to observe wide-ranging differences in TRD prevalence estimates. The landmark study, Sequenced Treatment Alternatives to Relieve Depression (STAR*D), was one of the first significant studies which helped to better characterize the patients with TRD.…”