Reasons for Discontinuation or Change of Selective Serotonin Reuptake Inhibitors in Online Drug Reviews

Abstract

ImportanceSelective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed medication class to treat a variety of mental disorders. However, adherence to SSRIs is low, and uncovering the reasons for discontinuation among SSRI users is an important first step to improving medication persistence.ObjectiveTo identify the reasons SSRIs are discontinued or changed, as reported by patients and caregivers in online drug reviews.Design, Setting, and ParticipantsThis qualitative study used natural language processing and machine learning to extract mentions of changes in SSRI intake from 667 drug reviews posted on the online health forum WebMD from September 1, 2007, to August 31, 2021. The type of medication change, including discontinuation, switch to another medication, or dose change and the reason for the change were manually annotated. In each instance in which an adverse event was reported, the event was categorized using Medical Dictionary for Regulatory Activities primary system organ class (SOC) codes, and its relative frequency was compared with that in spontaneous reporting systems maintained by the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency.Main Outcomes and MeasuresReasons for SSRI medication change as assessed using SOC codes.ResultsIn total, 667 reviews posted by 659 patients or caregivers (516 [78%] of patients were female; 410 [62%] 25-54 years of age) were identified that indicated a medication change: 335 posts indicated SSRI discontinuation, 188 posts indicated dose change, and 179 posts indicated switched medications. Most authors 625 (95%) were patients. The most common reason for medication discontinuation or switching was adverse events experienced, and the most common reason for dose change was titration. Both uptitration and downtitration were initiated by either a health care professional or patient. The most common adverse events were classified by SOC codes as psychiatric disorders, including insomnia, loss of libido, and anxiety. Compared with those in regulatory data, psychiatric adverse events, adverse events recorded by investigations (mostly weight gain) and adverse events associated with the reproductive system (mostly erectile dysfunction) were reported disproportionately more often.Conclusions and RelevanceThis qualitative study of online drug reviews found that useful information was provided directly by patients or their caregivers regarding their medication behavior, specifically, information regarding SSRI treatment changes that may inform interventions to improve adherence. These findings suggest that these reported adverse events may be associated with SSRI persistence and that people may feel more inclined to report such events on social media than to clinicians or regulatory agencies.

The value of social media analysis for adverse events detection and pharmacovigilance: a Scoping Review (Preprint)

“…It was apparent from our study that social media data may prove most fruitful for more timely hypothesis generation of new or unexpected adverse events and for detecting reports of mild symptomatic events. Knowledge of mild symptomatic events is difficult to quantify and has been shown through social media to play a role in adherence patterns [107,108] and coping strategies [106]. Future research that uses state-of-the-art NLP methods to identify personal experiences of adverse events from a range of platforms and that can directly capture reports of medication change alongside the reasons for change poses to bring the best return-on-investment for the incorporation of social media data with other traditional data sources.…”

Effectiveness of Vortioxetine for the Treatment of Emotional Blunting in Patients with Major Depressive Disorder Experiencing Inadequate Response to SSRI/SNRI Monotherapy in Spain: Results from the COMPLETE Study

“… 36 , 37 For example, in a recent study, insomnia was found to be one of the most common reasons for treatment discontinuation in patients receiving SSRIs. 38 Available data suggest that rates of treatment-emergent insomnia are lower in patients treated with vortioxetine than in those receiving SSRIs and SNRIs. 36 , 37 In a meta-analysis of TEAEs in 11 short-term, randomized, double-blind, placebo-controlled studies of vortioxetine 5–20 mg/day in patients with MDD, the incidence of insomnia was 2.0–5.1% for vortioxetine versus 4.0% for placebo.…”