Section for Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
Section for Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Copenhagen Phase IV unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark.
J Affect Disord. 2021 May 15;287:204-213. doi: 10.1016/j.jad.2021.03.029. Epub 2021 Mar 17.
To describe treatment patterns in patients with treatment-resistant depression (TRD) and major depressive disorder (MDD) stratified by depression severity and year of diagnosis. Patterns of treatment were also compared to country-specific guidelines.
All adults registered first time with a hospital contact due to MDD from 1996 through 2015 were identified and followed for all dispensed prescriptions of antidepressants, antipsychotics, lithium, initiation of electroconvulsive therapy (ECT), and psychotherapy in Danish registers 12 months before and after their hospital MDD diagnosis. TRD was characterized by two shifts in treatment.
We identified 197,615 patients of whom 15% developed TRD. In total, 88% of patients started treatment with antidepressants or ECT. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently used treatment during the study period and more than half (50.7%) of patients changed treatment at least once. Among patients with TRD, serotonin and noradrenaline reuptake inhibitors (SNRIs) were the most frequently used treatment (55.9%), and 37.0% initiated a new treatment the following year. SSRIs and SNRIs were part of most combinations of treatment, regardless of depression severity, year of diagnosis, or presence of TRD.
15% of patients met the criteria for TRD. Irrespective of patient characteristics and year of diagnosis, SSRIs and SNRIs are the most used treatments for depression, even after patients met the criteria for TRD. We confirm that guidelines for first treatment were followed for most patients diagnosed with MDD in Denmark, but for patients with TRD, choice of treatment was arbitrary.
根据抑郁严重程度和诊断年份，描述治疗抵抗性抑郁症（TRD）和重度抑郁症（MDD）患者的治疗模式。还将比较这些治疗模式与各国的指南。
在丹麦登记处，从 1996 年至 2015 年，所有首次因 MDD 而与医院接触的成年人都被识别出来，并在他们的 MDD 诊断前 12 个月和后 12 个月，对他们所有的抗抑郁药、抗精神病药、锂、电惊厥治疗（ECT）和心理治疗的处方进行了随访。TRD 的特征是两次治疗转换。
我们确定了 197615 名患者，其中 15%的患者患有 TRD。总的来说，88%的患者开始接受抗抑郁药或 ECT 治疗。在研究期间，选择性 5-羟色胺再摄取抑制剂（SSRIs）是最常用的治疗方法，超过一半（50.7%）的患者至少改变过一次治疗。在 TRD 患者中，血清素和去甲肾上腺素再摄取抑制剂（SNRIs）是最常用的治疗方法（55.9%），37.0%的患者在次年开始新的治疗。SSRIs 和 SNRIs 是大多数治疗组合的一部分，无论抑郁严重程度、诊断年份或是否存在 TRD。
15%的患者符合 TRD 的标准。无论患者的特征和诊断年份如何，SSRIs 和 SNRIs 都是抑郁症最常用的治疗方法，即使患者符合 TRD 的标准后也是如此。我们证实，丹麦大多数被诊断为 MDD 的患者都遵循了治疗的指南，但对于 TRD 患者，治疗的选择是任意的。
