Janssen, High Wycombe, UK.
Janssen, High Wycombe, UK.
J Psychiatr Res. 2021 Jul;139:172-178. doi: 10.1016/j.jpsychires.2021.05.026. Epub 2021 May 22.
Major depressive disorder (MDD) is a chronic recurrent or episodic psychiatric illness that can be successfully treated with oral antidepressants, yet one-in-three patients do not respond to currently-available treatments. According to the FDA and EMA, patients are considered to have treatment-resistant depression (TRD) when their MDD fails to respond adequately to ≥2 successive antidepressants in a single episode.
To describe current clinical management of patients with MDD and TRD in England, including treatment strategies and referral to secondary mental healthcare.
A retrospective cohort study of adult patients identified in primary care with diagnosed MDD, including a TRD subgroup (≥2 treatment failures as determined by treatment dynamics) was conducted using the Clinical Practice Research Datalink GOLD primary care database linked to Hospital Episode Statistics and Mental Health Services Data Set data (Protocol 19_019R).
41,375 patients with MDD (mean age 44yrs, 62% female, median follow-up 29mths); and 1,051 (3%) patients with TRD were identified. Mean time-to-TRD was 18 months. Most patients (>99%) received first-line antidepressant monotherapy. Following TRD criteria being met, antidepressant monotherapy use remained most frequent from TRD first-line (70%) to fifth-line (48%). Dual/triple antidepressant use remained constant (range:24%-26%), while augmented antidepressant use increased from TRD first-line (7%) to third-line (17%). Minimal non-pharmacological therapies were observed.
Despite current clinical guidelines recommending a stepwise approach, many patients frequently cycle through numerous antidepressants with similar mechanisms of action and efficacy. These findings indicate a high unmet need for new treatments that improve outcomes in these patient populations.
重度抑郁症（MDD）是一种慢性复发性或发作性精神疾病，可以通过口服抗抑郁药成功治疗，但三分之一的患者对现有治疗方法没有反应。根据 FDA 和 EMA 的规定，当患者的 MDD 在单次发作中对≥2 种连续的抗抑郁药反应不足时，被认为患有治疗抵抗性抑郁症（TRD）。
描述英国 MDD 和 TRD 患者的当前临床管理，包括治疗策略和转介到二级精神保健。
使用临床实践研究数据链接 GOLD 初级保健数据库，对初级保健中诊断为 MDD 的成年患者（包括 TRD 亚组（根据治疗动态确定的≥2 种治疗失败））进行回顾性队列研究，并与医院发病统计数据和精神卫生服务数据集数据相关联（方案 19_019R）。
共确定了 41375 例 MDD 患者（平均年龄 44 岁，62%为女性，中位随访时间为 29 个月）和 1051 例（3%）TRD 患者。达到 TRD 标准的平均时间为 18 个月。大多数患者（>99%）接受一线抗抑郁药单药治疗。在满足 TRD 标准后，TRD 一线（70%）至五线（48%）抗抑郁药单药治疗仍最为常见。双联/三联抗抑郁药治疗保持不变（范围：24%-26%），而增效抗抑郁药治疗从 TRD 一线（7%）增加到三线（17%）。观察到最低限度的非药物治疗。
尽管目前的临床指南建议采用逐步治疗方法，但许多患者经常使用具有相似作用机制和疗效的多种抗抑郁药。这些发现表明，需要新的治疗方法来改善这些患者群体的治疗效果，以满足高度未满足的需求。
