Impact of Duration of Antidepressant Treatment on the Risk of Occurrence of a New Sequence of Antidepressant Treatment

Abstract

The lower risk of re-initiation of antidepressant treatment in persons with shorter-than-recommended duration of antidepressant treatment might be explained by overprescription of antidepressants in persons with sub-threshold symptoms.

Social Inequalities in Early Antidepressant Discontinuation

“…The fund's beneficiaries are mainly salaried workers, including workers who have become unemployed. The cohort included all beneficiaries with a new episode of antidepressant treatment, defined as no antidepressant prescription claims in the six months before the index claim (8,(29)(30)(31), between July 1, 2008, and June 30,2009. We included all new treatments prescribed by private general practitioners.…”

“…Because prescriptions are dispensed in France for a maximum of 28 days (31), this definition refers to episodes of treatment lasting three months or less. We classified new treatments into four categories according to the type of antidepressant first dispensed during the study period: selective serotonin reuptake inhibitors (SSRIs), tricyclics, other antidepressants (including venlafaxine, a serotonin-norepinephrine reuptake inhibitor), and combined antidepressants (such as two or more types of antidepressant).…”

“…We classified new treatments into four categories according to the type of antidepressant first dispensed during the study period: selective serotonin reuptake inhibitors (SSRIs), tricyclics, other antidepressants (including venlafaxine, a serotonin-norepinephrine reuptake inhibitor), and combined antidepressants (such as two or more types of antidepressant). We built a coprescription variable for the dispensing of anxiolytics or hypnotics at least once within the six months after the index claim, and we used the coprescription of antipsychotics or lithium (at least one claim during the same period) as a marker of severe mental illness (31).…”

“…Chronic status is attributed to persons with specific and chronic diseases that are costly to treat (defined by NHIF) and that make patients eligible for 100% reimbursement for treatment. We used this information as a proxy for the presence of severe somatic (yesno) or chronic psychiatric illnesses (none, major depression, severe anxiety disorder, or other severe psychiatric illness, such as psychosis) (31).…”

“…As in most observational studies of administrative databases (6,21,31,(40)(41)(42), information about diagnoses and disease severity was not available, except for a subset of patients with chronic or severe cases of depression. To improve our consideration of case severity, we adjusted the multilevel model for claims for antipsychotics or lithium and for visits with private psychiatrists, both of which can be considered markers of psychiatric disease severity given that general practitioners refer patients to psychiatrists more frequently in severe versus mild cases of depression (13,34).…”