Treatment Patterns and Sequences of Pharmacotherapy for Patients Diagnosed with Depression in the United States: 2014 through 2019

Abstract

Background: Understanding how patients are treated in the real-world is vital to identifying potential gaps in care. We describe the current pharmacologic treatment patterns for the treatment of depression. Methods: Patients with depression were identified from four large national claims databases during 1/1/2014-1/31/2019. Patients had ≥2 diagnoses for depression or an inpatient hospitalization with a diagnosis of depression. Patients were required to have enrollment in the database ≥1 year prior to and three years following their first depression diagnosis. Treatment patterns were captured at the class level and included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, and antipsychotics. Treatment patterns were captured during all available follow-up. Results: We identified 269,668 patients diagnosed with depression. The proportion not receiving any pharmacological treatment during follow-up ranged from 29% to 52%. Of the treated, approximately half received ≥2 different classes of therapy, a quarter received ≥3 classes and more than 10% received 4 or more. SSRIs were the most common first-line treatment; however, many patients received an anxiolytic, hypnotic/sedative, or antipsychotic prior to any antidepressive treatment. Treatment with a combination of classes ranged from approximately 20% of first-line therapies to 40% of fourth-line. Conclusions: Many patients diagnosed with depression go untreated and many others receive a non-antidepressant medication class as their first treatment. More than half of patients received more than one type of treatment class during the study follow up, suggesting that the first treatment received may not be optimal for most patients.

Care pathways for people with major depressive disorder: A European Brain Council Value of Treatment study

“…International: Studies of diagnosed patients have reported that (cross-sectionally), the proportion of patients not receiving treatment is approximately one third [32, 59], or as low as 15% [60]. In cohorts containing undiagnosed individuals, rates of 71% untreated [61], or 84% inadequately treated [30] have been reported.…”

The sociodemographic and clinical profile of patients with major depressive disorder receiving SSRIs as first-line antidepressant treatment in European countries

“…Selective-serotonin reuptake inhibitors (SSRIs) represent a very well studied class of antidepressant (AD) medication that is consistently recommended as the first-line psychopharmacotherapy for major depressive disorder (MDD) in clinical practice guidelines (CPG) throughout the world [25]. Accordingly, it is not surprising that SSRIs are the most commonly prescribed ADs in numerous patient populations with different ethnical and geographical backgrounds [2,21,27,29,46].…”

Dose-Response Relationship in Selective Serotonin and Norepinephrine Reuptake Inhibitors in the Treatment of Major Depressive Disorder: A Meta-Analysis and Network Meta-Analysis of Randomized Controlled Trials

“…Selective serotonin and norepinephrine reuptake inhibitors (SNRI), such as venlafaxine, and duloxetine, are among the most often prescribed antidepressants [1][2][3]. Antidepressant dose escalation is common in the clinical routine if there is insufficient response to initial treatment [4].…”