Jain Rakesh, Higa Sara, Keyloun Katelyn, Park Julie, Bonafede Machaon, Tung Amy, Gillard Patrick, Cutler Andrew J
Texas Tech University School of Medicine-Permian Basin, Midland, TX, USA.
, 2500 W William Cannon Drive, Suite 505, Austin, TX, 78745, USA.
Drugs Real World Outcomes. 2022 Sep;9(3):477-486. doi: 10.1007/s40801-022-00316-4. Epub 2022 Jun 30.
Major depressive disorder, a highly prevalent mental health condition, can be challenging to treat.
We aimed to characterize treatment patterns within and across multiple major depressive episodes in patients receiving treatment for major depressive disorder.
Adults with newly diagnosed major depressive disorder and one or more major depressive episodes were identified using the IBM MarketScan Commercial database. Eligible patients had 12 months of continuous enrollment before and after diagnosis. Lines of therapy were periods of continuous treatment with one or more antidepressant claims. Antidepressant, atypical antipsychotic, or mood stabilizer regimens as monotherapy or adjunctive therapy were characterized by lines of therapy and major depressive episodes. Descriptive analyses were performed.
A total of 455,082 patients were included in the analysis. The majority of treatment regimens were monotherapy, which decreased with subsequent lines of therapy, while adjunctive treatments increased with subsequent lines of therapy. There were 1860 unique adjunctive regimens identified. Of the 40,315 patients (9%) who received adjunctive therapy, 8024 (20%; 2% of all patients) received atypical antipsychotic-adjunctive regimens. Only 19% of patients treated with atypical antipsychotic-adjunctive therapy discontinued treatment versus 42% of monotherapy-treated patients. On average, patients who received an adjunctive atypical antipsychotic received it as their third line of therapy and approximately 400 days after the initial antidepressant treatment.
In this study, many patients continued monotherapy major depressive disorder regimens and experienced multiple treatment changes. Few patients were treated with adjunctive therapy. These results suggest underutilization of potentially effective treatments, which represents an opportunity to optimize the treatment of patients with major depressive disorder.
重度抑郁症是一种高度普遍的心理健康状况，治疗颇具挑战性。
我们旨在描述接受重度抑郁症治疗的患者在多个重度抑郁发作期间及发作之间的治疗模式。
使用IBM MarketScan商业数据库识别出患有新诊断重度抑郁症且有一次或多次重度抑郁发作的成年人。符合条件的患者在诊断前后连续入组12个月。治疗线是指使用一种或多种抗抑郁药物的连续治疗期。以治疗线和重度抑郁发作来描述抗抑郁药、非典型抗精神病药或心境稳定剂作为单一疗法或辅助疗法的治疗方案。进行描述性分析。
共有455,082名患者纳入分析。大多数治疗方案为单一疗法，其比例随后续治疗线下降，而辅助治疗随后续治疗线增加。共识别出1860种独特的辅助治疗方案。在接受辅助治疗的40,315名患者（9%）中，8024名（20%；占所有患者的2%）接受非典型抗精神病药辅助治疗方案。接受非典型抗精神病药辅助治疗的患者中只有19%停止治疗，而单一疗法治疗的患者中这一比例为42%。平均而言，接受辅助非典型抗精神病药治疗的患者将其作为第三线治疗，且在初始抗抑郁治疗后约400天开始使用。
在本研究中，许多患者继续采用单一疗法治疗重度抑郁症方案并经历多次治疗变更。很少有患者接受辅助治疗。这些结果表明潜在有效治疗方法未得到充分利用，这代表了优化重度抑郁症患者治疗的一个机会。
