Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

Garcı́a-Toro, Mauro; Medina, Esteban; Galan, J.L.; González, Miguel A.; Mauriño, Jorge

doi:10.1186/1471-244x-12-143

Cited by 29 publications

(21 citation statements)

References 27 publications

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“…This is similar to the 20% quoted in a study done in Korea [20]. In a multi-centre study in Spain, Garcia-Toro et al found that about 19% patients [29] were prescribed augmentation therapy, with atypical antipsychotics being the more common choice (rather similar to our case).…”

Section: Discussionsupporting

confidence: 90%

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Antidepressant Prescribing Patterns for Depressive and Anxiety Disorders in a Singapore Hospital

Soh¹,

Lim

Chan³

et al. 2015

OJPsych

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Objective: Although antidepressants are the recommended first-line pharmacological treatments for depressive and anxiety disorders, their prescribing patterns have not been studied in Singapore. We investigate antidepressant prescription patterns for outpatients with depressive and anxiety disorders in a general hospital in Singapore. We hypothesize that intolerance to side effects and lack of efficacy may contribute to medication switching, and that initiation of antidepressant therapy is not easily tolerated. Methods: A retrospective review of the casenotes of outpatients was carried out between January 2013 and December 2013. A total of 206 patients were randomly selected. The study was approved by the hospital's institutional review board. Data analysis was carried out using SPSS version 18. Results: There were more females than males (ratio 1.7:1) with a mean age of 50.6 ± 15.2 years. Depressive disorder, comprising 50% of the sample, was the most frequent diagnosis followed by anxiety disorder (27.2%), mixed anxiety-depression (16%) and adjustment disorder (5.8%). Almost all patients (97.1%) were prescribed antidepressants, the most common being selective serotonin reuptake inhibitors (SSRI) (75.5%), followed by the noradrenaline and specific serotonin antidepressant (NaSSA) (13.5%) and tricyclic antidepressants (TCA) (8.5%). Patients prescribed SSRIs tended to be younger and better educated (p = 0.0005). More than half of the patients (52.1%) required antidepressant switching mainly due to lack of efficacy and intolerance of side effects. Combination therapy was prescribed for 17% of patients with SSRI-NaSSA, the most preferred combination. Nearly a quarter (23.8%) patients required augmentation therapy with atypical antipsychotics. Combination (p = 0.024) and augmentation (p = 0.033) were utilized more often for depression than for anxiety disorders. Conclusion: Antidepressant medications are commonly prescribed for depression and anxiety disorders. The main reasons for switching antidepressants were intolerance and lack of efficacy. That about half of the patients reported side effects necessitating medication change confirmed our hypothesis that an-*

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Section: Discussionsupporting

confidence: 90%

“…For example, researchers in France, based on a general practice database, showed that 16% of patients switched antidepressants, with 72% occurring within 3 months of treatment initiation [28]. Others reported switching for the purpose of optimizing treatment in about 40% of patients [29].…”

Section: Discussionmentioning

confidence: 99%

Antidepressant Prescribing Patterns for Depressive and Anxiety Disorders in a Singapore Hospital

Soh¹,

Lim

Chan³

et al. 2015

OJPsych

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“…The low application of the combination strategy in this primary-care population may reflect the NICE recommendations in effect during the study period, which state that this approach should only be implemented following discussion with a consultant psychiatrist 26,30 . Few studies have reported on treatment choices after first-line therapy in clinical practice and none have investigated choices made in primary care [41][42][43] . A small study in Spain of psychiatrists' choices of second-line treatment in community care noted that switching was the most common strategy (40%), while combination and augmentation were implemented to a lower degree (24% and 18%, respectively) 41 .…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have reported on treatment choices after first-line therapy in clinical practice and none have investigated choices made in primary care [41][42][43] . A small study in Spain of psychiatrists' choices of second-line treatment in community care noted that switching was the most common strategy (40%), while combination and augmentation were implemented to a lower degree (24% and 18%, respectively) 41 . Surveys of psychiatrists have also reported that their preferred option would be switching 42,43 .…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapeutic strategies for patients treated for depression in UK primary care: a database analysis

Lamy¹,

Chollet²,

Clay

et al. 2015

Current Medical Research and Opinion

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This study provides extensive real-world information on the prescribing patterns and treatment outcomes for a large cohort of patients treated for depression with antidepressants in primary care. Switching is more frequently used than augmentation or combination treatment, with decreasing effectiveness across successive lines. Key limitations of the study were: (i) risk of selection bias due to the use of inclusion criteria based on depression diagnoses recorded by the practitioner; and (ii) reliance on prescribing patterns as proxies for clinical outcomes, such as recovery.

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“…The current gold-standard treatment for psychiatric illnesses, MDD and anxiety disorders in particular, are antidepressants medications. Though antidepressants have a relatively high efficacy, a large proportion of individuals with psychiatric illnesses do not respond to these first-line treatments, and thus need to try alternatives (Garcia-Toro et al, 2012). Further, many antidepressant users also experience side effects such as restlessness, nausea, vomiting, anxiety, insomnia, sexual dysfunction, gastrointestinal cramps and diarrhea, and headaches that can make the arduous process of searching for effective treatments even harder (Stahl, 1998).…”

Section: Treatment Feasibilitymentioning

confidence: 99%

Effect of Fecal Microbiota Transplant on Symptoms of Psychiatric Disorders: A Systematic Review

Meyyappan

Forth

Wallace

et al. 2020

Preprint

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Background: The Gut-Brain-Axis is a bidirectional signaling pathway between the gastrointestinal (GI) tract and the brain. The hundreds of trillions of microorganisms populating the gastrointestinal tract are thought to modulate this connection, and have far reaching effects on the immune system, central and autonomic nervous systems, and GI functioning. These interactions have also been linked to various psychiatric illnesses such as depression, anxiety, substance abuse, and eating disorders. It is hypothesized that techniques aimed at strengthening and repopulating the gut microbiome, such as Fecal Microbiota Transplant (FMT), may be useful in the prevention and treatment of psychiatric illnesses. Methods: A systematic search of five databases was conducted using key terms related to FMT and psychiatric illnesses. All results were then evaluated based on specific eligibility criteria. Results: Twenty-one studies met the eligibility criteria and were analysed for reported changes in mood and behavioural measures indicative of psychiatric wellbeing. The studies included were either entirely clinical (n=7), preclinical with human donors (n=7), or entirely preclinical (n=7). All studies found a decrease in depressive and anxiety-like symptoms and behaviours resulting from the transplantation of healthy microbiota. The inverse was also found, with the transmission of depressive and anxiety-like symptoms and behaviours resulting from the transplantation of microbiota from psychiatrically ill donors to healthy recipients. Conclusion: There appears to be strong evidence for the treatment and transmission of psychiatric illnesses through FMT. Further research with larger sample sizes and stronger scientific design is warranted in order to fully determine the efficacy and safety of this potential treatment.

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Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

Cited by 29 publications

References 27 publications

Antidepressant Prescribing Patterns for Depressive and Anxiety Disorders in a Singapore Hospital

Antidepressant Prescribing Patterns for Depressive and Anxiety Disorders in a Singapore Hospital

Pharmacotherapeutic strategies for patients treated for depression in UK primary care: a database analysis

Effect of Fecal Microbiota Transplant on Symptoms of Psychiatric Disorders: A Systematic Review

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