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Background: Understanding how patients are treated in the real-world is vital to identifying potential gaps in care. We describe the current pharmacologic treatment patterns for the treatment of depression. Methods: Patients with depression were identified from four large national claims databases during 1/1/2014-1/31/2019. Patients had ≥2 diagnoses for depression or an inpatient hospitalization with a diagnosis of depression. Patients were required to have enrollment in the database ≥1 year prior to and three years following their first depression diagnosis. Treatment patterns were captured at the class level and included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, and antipsychotics. Treatment patterns were captured during all available follow-up. Results: We identified 269,668 patients diagnosed with depression. The proportion not receiving any pharmacological treatment during follow-up ranged from 29% to 52%. Of the treated, approximately half received ≥2 different classes of therapy, a quarter received ≥3 classes and more than 10% received 4 or more. SSRIs were the most common first-line treatment; however, many patients received an anxiolytic, hypnotic/sedative, or antipsychotic prior to any antidepressive treatment. Treatment with a combination of classes ranged from approximately 20% of first-line therapies to 40% of fourth-line. Conclusions: Many patients diagnosed with depression go untreated and many others receive a non-antidepressant medication class as their first treatment. More than half of patients received more than one type of treatment class during the study follow up, suggesting that the first treatment received may not be optimal for most patients.
Keywords
Depression, treatment patterns, antidepressants, real-world evidence
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CURRENT STATUS: Published
View the published article at BMC Psychiatry.
Version 3
Posted 19 Dec, 2019
No community comments so far
Editorial decision: Accept
On 22 Dec, 2019
Editor assigned
On 17 Dec, 2019
Submission checks complete
On 16 Dec, 2019
Editor invited
On 16 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 13 Dec, 2019
Review #2 received
Received 08 Dec, 2019
Reviewer #2 agreed
On 24 Nov, 2019
Reviewers invited
Invitations sent on 22 Nov, 2019
Reviewer #1 agreed
On 22 Nov, 2019
Review #1 received
Received 22 Nov, 2019
Editor assigned
On 11 Nov, 2019
Submission checks complete
On 10 Nov, 2019
Editor invited
On 10 Nov, 2019
No comments provided
Editorial decision: Major revision
On 04 Nov, 2019
Reviewer #2 agreed
On 30 Oct, 2019
Review #2 received
Received 30 Oct, 2019
Review #1 received
Received 29 Oct, 2019
Reviewer #1 agreed
On 16 Oct, 2019
Reviewers invited
Invitations sent on 11 Oct, 2019
Submission checks complete
On 08 Oct, 2019
Editor assigned
On 02 Oct, 2019
First submitted
On 01 Oct, 2019
Editor invited
On 01 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Psychiatry
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See the published version of this preprint at BMC Psychiatry.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Psychiatry.
Version 3
Posted 19 Dec, 2019
No community comments so far
Editorial decision: Accept
On 22 Dec, 2019
Editor assigned
On 17 Dec, 2019
Submission checks complete
On 16 Dec, 2019
Editor invited
On 16 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 13 Dec, 2019
Review #2 received
Received 08 Dec, 2019
Reviewer #2 agreed
On 24 Nov, 2019
Reviewers invited
Invitations sent on 22 Nov, 2019
Reviewer #1 agreed
On 22 Nov, 2019
Review #1 received
Received 22 Nov, 2019
Editor assigned
On 11 Nov, 2019
Submission checks complete
On 10 Nov, 2019
Editor invited
On 10 Nov, 2019
No comments provided
Editorial decision: Major revision
On 04 Nov, 2019
Reviewer #2 agreed
On 30 Oct, 2019
Review #2 received
Received 30 Oct, 2019
Review #1 received
Received 29 Oct, 2019
Reviewer #1 agreed
On 16 Oct, 2019
Reviewers invited
Invitations sent on 11 Oct, 2019
Submission checks complete
On 08 Oct, 2019
Editor assigned
On 02 Oct, 2019
First submitted
On 01 Oct, 2019
Editor invited
On 01 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Psychiatry
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Psychiatry.
Background: Understanding how patients are treated in the real-world is vital to identifying potential gaps in care. We describe the current pharmacologic treatment patterns for the treatment of depression. Methods: Patients with depression were identified from four large national claims databases during 1/1/2014-1/31/2019. Patients had ≥2 diagnoses for depression or an inpatient hospitalization with a diagnosis of depression. Patients were required to have enrollment in the database ≥1 year prior to and three years following their first depression diagnosis. Treatment patterns were captured at the class level and included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, and antipsychotics. Treatment patterns were captured during all available follow-up. Results: We identified 269,668 patients diagnosed with depression. The proportion not receiving any pharmacological treatment during follow-up ranged from 29% to 52%. Of the treated, approximately half received ≥2 different classes of therapy, a quarter received ≥3 classes and more than 10% received 4 or more. SSRIs were the most common first-line treatment; however, many patients received an anxiolytic, hypnotic/sedative, or antipsychotic prior to any antidepressive treatment. Treatment with a combination of classes ranged from approximately 20% of first-line therapies to 40% of fourth-line. Conclusions: Many patients diagnosed with depression go untreated and many others receive a non-antidepressant medication class as their first treatment. More than half of patients received more than one type of treatment class during the study follow up, suggesting that the first treatment received may not be optimal for most patients.
Figure 1
Figure 2
Figure 3
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