Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study
Background Despite the availability of effective therapies, many patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD). Aims To evaluate and compare prescribing patterns, contact with specialist services and treatment outcomes in patients with MDD and TRD. Met...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2024-01-01
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| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472423006270/type/journal_article |
| _version_ | 1797351417558597632 |
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| author | Sofia Pappa Moulesh Shah Sophie Young Tazneem Anwar Timothy Ming |
| author_facet | Sofia Pappa Moulesh Shah Sophie Young Tazneem Anwar Timothy Ming |
| author_sort | Sofia Pappa |
| collection | DOAJ |
| description |
Background
Despite the availability of effective therapies, many patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD).
Aims
To evaluate and compare prescribing patterns, contact with specialist services and treatment outcomes in patients with MDD and TRD.
Method
This was a retrospective analysis of linked primary and secondary care National Health Service data in the north-west London Discover-NOW data-set. Eligible patients were adults who had diagnostic codes for depression and had been prescribed at least one antidepressant between 2015 and 2020.
Results
A total of 110 406 patients were included, comprising 101 333 (92%) with MDD and 9073 (8%) with TRD. Patients with TRD had significantly higher risks of suicidal behaviour and comorbidities such as anxiety, asthma, and alcohol or substance misuse (all P < 0.0001). Citalopram, sertraline, fluoxetine and mirtazapine accounted for 83% of MDD and 71% of TRD prescriptions. Use of antidepressant switching (1% MDD, 7% TRD) and combination therapy (1%, 5%) was rare, whereas augmentation occurred more frequently in the TRD group (4%, 35%). Remission was recorded in 42 348 (42%) patients with MDD and 1188 (13%) with TRD (P < 0.0001), whereas relapse was seen in 20 970 (21%) and 4923 (54%), respectively (P < 0.0001). Mean times from diagnosis to first contact with mental health services were 38.9 (s.d. 33.6) months for MDD and 41.5 (s.d. 32.0) months for TRD (P < 0.0001).
Conclusions
There appears to be a considerable difference between treatment guidelines for depression and TRD and the reality of clinical practice. Long-term treatment with single antidepressants, poor remission, and high relapse rates among patients in primary care highlight the need to optimise treatment pathways and access to newer therapies.
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| first_indexed | 2024-03-08T13:00:08Z |
| format | Article |
| id | doaj.art-3c7c06c0997049fb8ec146de3fc6d594 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-03-08T13:00:08Z |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-3c7c06c0997049fb8ec146de3fc6d5942024-01-19T09:15:36ZengCambridge University PressBJPsych Open2056-47242024-01-011010.1192/bjo.2023.627Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort studySofia Pappa0Moulesh Shah1Sophie Young2https://orcid.org/0000-0002-4198-9586Tazneem Anwar3Timothy Ming4Department of Brain Sciences, Faculty of Medicine, Imperial College, London, UK; and West London NHS Trust, London, UKImperial College Health Partners, London, UKImperial College Health Partners, London, UKJanssen Cilag Ltd, High Wycombe, UKJanssen Cilag Ltd, High Wycombe, UK Background Despite the availability of effective therapies, many patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD). Aims To evaluate and compare prescribing patterns, contact with specialist services and treatment outcomes in patients with MDD and TRD. Method This was a retrospective analysis of linked primary and secondary care National Health Service data in the north-west London Discover-NOW data-set. Eligible patients were adults who had diagnostic codes for depression and had been prescribed at least one antidepressant between 2015 and 2020. Results A total of 110 406 patients were included, comprising 101 333 (92%) with MDD and 9073 (8%) with TRD. Patients with TRD had significantly higher risks of suicidal behaviour and comorbidities such as anxiety, asthma, and alcohol or substance misuse (all P < 0.0001). Citalopram, sertraline, fluoxetine and mirtazapine accounted for 83% of MDD and 71% of TRD prescriptions. Use of antidepressant switching (1% MDD, 7% TRD) and combination therapy (1%, 5%) was rare, whereas augmentation occurred more frequently in the TRD group (4%, 35%). Remission was recorded in 42 348 (42%) patients with MDD and 1188 (13%) with TRD (P < 0.0001), whereas relapse was seen in 20 970 (21%) and 4923 (54%), respectively (P < 0.0001). Mean times from diagnosis to first contact with mental health services were 38.9 (s.d. 33.6) months for MDD and 41.5 (s.d. 32.0) months for TRD (P < 0.0001). Conclusions There appears to be a considerable difference between treatment guidelines for depression and TRD and the reality of clinical practice. Long-term treatment with single antidepressants, poor remission, and high relapse rates among patients in primary care highlight the need to optimise treatment pathways and access to newer therapies. https://www.cambridge.org/core/product/identifier/S2056472423006270/type/journal_articleMajor depressive disordertreatment-resistant depressionreal-world datatreatment pathway |
| spellingShingle | Sofia Pappa Moulesh Shah Sophie Young Tazneem Anwar Timothy Ming Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study BJPsych Open Major depressive disorder treatment-resistant depression real-world data treatment pathway |
| title | Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study |
| title_full | Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study |
| title_fullStr | Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study |
| title_full_unstemmed | Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study |
| title_short | Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study |
| title_sort | care pathways prescribing practices and treatment outcomes in major depressive disorder and treatment resistant depression retrospective population based cohort study |
| topic | Major depressive disorder treatment-resistant depression real-world data treatment pathway |
| url | https://www.cambridge.org/core/product/identifier/S2056472423006270/type/journal_article |
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