Finding treatment-resistant depression in real-world data: How a data-driven approach compares with expert-based heuristics

Cepeda, M. Soledad; Reps, Jenna; Fife, Daniel; Blacketer, Clair; Stang, Paul; Ryan, Patrick B.

doi:10.1002/da.22705

Cited by 37 publications

(37 citation statements)

References 22 publications

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“…Population‐based studies have shown that depression and insomnia are strongly correlated and that subjects with depression have a shorter duration of sleep at night compared to those who are not depressed (Cepeda, Stang, Blacketer, Kent, & Wittenberg, ; van Mill, Vogelzangs, van Someren, Hoogendijk, & Penninx, ). The findings of the present study suggest that subjects who developed TRD were more symptomatic at baseline than those who did not develop TRD; they had more anxiety and pain and could not sleep.…”

Section: Discussionmentioning

confidence: 99%

Finding factors that predict treatment-resistant depression: Results of a cohort study

2018

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BackgroundTreatment for depressive disorders often requires subsequent interventions. Patients who do not respond to antidepressants have treatment‐resistant depression (TRD). Predicting who will develop TRD may help healthcare providers make more effective treatment decisions. We sought to identify factors that predict TRD in a real‐world setting using claims databases.MethodsA retrospective cohort study was conducted in a US claims database of adult subjects with newly diagnosed and treated depression with no mania, dementia, and psychosis. The index date was the date of antidepressant dispensing. The outcome was TRD, defined as having at least three distinct antidepressants or one antidepressant and one antipsychotic within 1 year after the index date. Predictors were age, gender, medical conditions, medications, and procedures 1 year before the index date.ResultsOf 230,801 included patients, 10.4% developed TRD within 1 year. TRD patients at baseline were younger; 10.87% were between 18 and 19 years old versus 7.64% in the no‐TRD group, risk ratio (RR) = 1.42 (95% confidence interval [CI] 1.37–1.48). TRD patients were more likely to have an anxiety disorder at baseline than non‐TRD patients, RR = 1.38 (95% CI 1.35–1.14). At 3.68, fatigue had the highest RR (95% CI 3.18–4.25). TRD patients had substance use disorders, psychiatric conditions, insomnia, and pain more often at baseline than non‐TRD patients.ConclusionTen percent of subjects newly diagnosed and treated for depression developed TRD within a year. They were younger and suffered more frequently from fatigue, substance use disorders, anxiety, psychiatric conditions, insomnia, and pain than non‐TRD patients.

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Section: Discussionmentioning

confidence: 99%

Finding factors that predict treatment-resistant depression: Results of a cohort study

2018

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“…In retrospective cohort studies from health services databases, TRD incidence estimates vary widely depending on several choices required to apply the definition of TRD. Unless a well-grounded basis for narrowing the range of these choices can be found, or a different analytic approach that does not depend on such choices [19] is adopted, estimates for the incidence and prevalence of TRD from such databases will be difficult to compare or interpret.…”

Section: Discussionmentioning

confidence: 99%

Treatment resistant depression incidence estimates from studies of health insurance databases depend strongly on the details of the operating definition

Fife

Reps

Cepeda

et al. 2018

Heliyon

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BackgroundHealth services databases provide population-based data that have been used to describe the epidemiology and costs of treatment resistant depression (TRD). This retrospective cohort study estimated TRD incidence and, via sensitivity analyses, assessed the variation of TRD incidence within the range of implementation choices.MethodsIn three US databases widely used for observational studies, we defined TRD as failure of two medications as evidenced by their replacement or supplementation by other medications, and set maximum durations (caps) for how long a medication regimen could remain in use and still be eligible to fail.ResultsTRD incidence estimates varied approximately 2-fold between the two databases (CCAE, Medicaid) that described socioeconomically different non-elderly populations; for a given cap varied 2-fold to 4-fold within each database across the other implementation choices; and if the cap was also allowed to vary, varied 6-fold or 7-fold within each database.LimitationsThe main limitations were typical of studies from health services databases and included the lack of complete -rather than recent - medical histories, the limited amount of clinical information, and the assumption that medication dispensed was consumed as directed.ConclusionIn retrospective cohort studies from health services databases, TRD incidence estimates vary widely depending on the implementation choices. Unless a firm basis for narrowing the range of these choices can be found, or a different analytic approach not dependent on such choices is adopted, TRD incidence and prevalence estimates from such databases will be difficult to compare or interpret.

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“…There is no consensus definition of TRD, but one of the most common definitions requires a minimum of two prior treatment failures and confirmation of prior adequate dose and duration [13]. Implementing such a definition in claims databases is challenging because it is difficult to ascertain why medications were changed or stopped -- improvement, lack of efficacy or adverse events [23, 24]. Nonetheless, there is a definition of TRD to be used in claims database studies that has been validated [23].…”

Section: Methodsmentioning

confidence: 99%

“…Implementing such a definition in claims databases is challenging because it is difficult to ascertain why medications were changed or stopped -- improvement, lack of efficacy or adverse events [23, 24]. Nonetheless, there is a definition of TRD to be used in claims database studies that has been validated [23]. Using this definition, TRD was defined as women with a diagnosis of depression who were dispensed 3 distinct antidepressants or 1 antidepressant and 1 antipsychotic in 1 year.…”

Section: Methodsmentioning

confidence: 99%

Treatment resistant depression in women with peripartum depression

Cepeda

Kern

Nicholson³

2019

BMC Pregnancy Childbirth

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Background Peripartum depression is a leading cause of disease burden for women and yet there is little evidence as to how often peripartum depression does not respond to treatment and becomes treatment resistant depression. We sought to determine the incidence of treatment resistant depression (TRD) in women with peripartum depression. Methods Population based retrospective cohort study using a large US claims database. Peripartum depression was defined as having a depression diagnosis during pregnancy or up to 6 months after the end of pregnancy. We included women with prevalent or incident depression. The outcome was the development of TRD within 1 year after the diagnosis of peripartum depression. TRD was defined as having 3 distinct antidepressants or 1 antidepressant and 1 antipsychotic in 1 year. Women with peripartum depression may not be exposed to pharmacological treatments early in pregnancy, therefore we created two groups: 1. women with peripartum depression, and 2. women with peripartum depression diagnosed 3 months before a live birth delivery or within 6 months after that delivery. Results There were 3,207,684 pregnant women, of whom 2.5% had peripartum depression. Of these women half had incident depression during pregnancy. Five percent of women with peripartum depression developed TRD within 1 year of the depression diagnosis. The risk of developing TRD was 50% higher in women with prevalent depression than in women with incident peripartum depression ( P < 0.0001). Results were similar in women with peripartum depression diagnosed later in their pregnancy. Women who went on to develop TRD had more substance use disorders, anxiety, insomnia and painful conditions. Conclusions TRD occurs in approximately 5% of women with peripartum depression. The risk of TRD is higher in pregnant women with a history of depression. Women who went on to develop TRD had more psychiatric comorbidities and painful conditions than women who did not. Electronic supplementary material The online version of this article (10.1186/s12884-019-2462-9) contains supplementary material, which is available to authorized users.

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Finding treatment-resistant depression in real-world data: How a data-driven approach compares with expert-based heuristics

Cited by 37 publications

References 22 publications

Finding factors that predict treatment-resistant depression: Results of a cohort study

Finding factors that predict treatment-resistant depression: Results of a cohort study

Treatment resistant depression incidence estimates from studies of health insurance databases depend strongly on the details of the operating definition

Treatment resistant depression in women with peripartum depression

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