Prescription patterns in unipolar depression: A nationwide Danish register-based study of 113,175 individuals followed for 10 years.
| Title: | Prescription patterns in unipolar depression: A nationwide Danish register-based study of 113,175 individuals followed for 10 years. |
|---|---|
| Authors: | Jorgensen A; Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark.; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.; Larsen EN; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.; Sloth MMB; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.; Kessing LV; Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark.; Osler M; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark. |
| Source: | Acta psychiatrica Scandinavica [Acta Psychiatr Scand] 2024 Feb; Vol. 149 (2), pp. 88-97. Date of Electronic Publication: 2023 Nov 21. |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 0370364 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-0447 (Electronic) Linking ISSN: 0001690X NLM ISO Abbreviation: Acta Psychiatr Scand Subsets: MEDLINE |
| Imprint Name(s): | Publication: Malden, MA : Wiley-Blackwell; Original Publication: Copenhagen : Munksgaard International Publishers |
| MeSH Terms: | Depressive Disorder*/drug therapy ; Depressive Disorder*/epidemiology; Antidepressive Agents/therapeutic use ; Denmark/epidemiology ; Depression/drug therapy ; Humans ; Selective Serotonin Reuptake Inhibitors ; Prescriptions |
| Abstract: | Background: Evidence-based use of antidepressant medications is of major clinical importance. We aimed to uncover precription patterns in a large cohort of patients with unipolar depression.; Material and Methods: Using Danish nationwide registers, we identified individuals with a first-time hospital diagnosis of unipolar depression between January 1st, 2001, and December 31st, 2016. Redemeed prescriptions of antidepressants from five years before to five years after diagnosis were retreived. Lithium and relevant antipsychotics were included. Data were analyzed with descriptive statistics including sunburst plots. Cox regressions were used to rank the risk of treatment failure according to antidepressant category and depression severity, as measured by hazard ratios of drug shift.; Results: The full study population consisted of 113,175 individuals. Selective Serotonin Reuptake Inhibitors was the predominantly prescribed first-line group, both before (55.4%) and after (47.7%) diagnosis and across depression severities. Changes of treatment strategy were frequent; 60.8%, 33.7%, and 17.1% reached a second, third, and fourth treatment trial after the hospital diagnosis, respectively. More than half of patients continued their pre-diagnosis antidepressant after diagnosis. The risk of change of treatment strategy was generally lower in mild-moderate depression and higher in severe depression, with tricyclic antidepressants carrying the highest risk in the former and the lowest risks in the latter. Overall, prescribing were often not in accordance with guidelines.; Conclusion: These findings uncover a potential for improving the clinical care for patients with unipolar depression through optimization of the use of marketed antidepressants.; (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.) |
| References: | GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789‐1858. doi:10.1016/S0140‐6736(18)32279‐7.; Sundhedsstyrelsen. Referenceprogram for unipolar depression hos voksne. Published online 2007. https://www.sst.dk/~/media/6F9CE14B6FF245AABCD222575787FEB7.ashx.; Cleare A, Pariante CM, Young AH, et al. Evidence‐based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2015;29(5):459‐525. doi:10.1177/0269881115581093.; Overview. Depression in adults: treatment and management | Guidance | NICE. Published June 29, 2022. Accessed April 5, 2023. https://www.nice.org.uk/guidance/ng222.; Bauer M, Pfennig A, Severus E, et al. World Federation of Societies of biological psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry. 2013;14(5):334‐385. doi:10.3109/15622975.2013.804195.; Gelenberg AJ, Freeman MP, Markowitz JC, et al. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. American Psychiatric Association; 2010.; Setkowski K, Boogert K, Hoogendoorn AW, Gilissen R, van Balkom AJLM. Guidelines improve patient outcomes in specialised mental health care: a systematic review and meta‐analysis. Acta Psychiatr Scand. 2021;144(3):246‐258. doi:10.1111/acps.13332.; Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta‐analysis. Lancet. 2018;391(10128):1357‐1366. doi:10.1016/S0140‐6736(17)32802‐7.; Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer‐term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905‐1917. doi:10.1176/ajp.2006.163.11.1905.; Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sorensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449‐490. doi:10.2147/clep.s91125.; Pottegård A, Schmidt SAJ, Wallach‐Kildemoes H, Sørensen HT, Hallas J, Schmidt M. Data resource profile: the Danish National Prescription Registry. Int J Epidemiol. 2017;46(3):798‐798f. doi:10.1093/ije/dyw213.; Gronemann FH, Petersen J, Alulis S, et al. Treatment patterns in patients with treatment‐resistant depression in Danish patients with major depressive disorder. J Affect Disord. 2021;287:204‐213. doi:10.1016/j.jad.2021.03.029.; Pedersen CB, Gotzsche H, Moller JO, Mortensen PB. The Danish civil registration system. A cohort of eight million persons. Dan Med Bull. 2006;53(4):441‐449.; Wu T, Dong S, Yang L, et al. Investigation of the pharmacological treatment patterns of Chinese patients with major depressive disorder under real‐world settings using multi‐channel sequence analysis. Front Psych. 2023;14:1089504. doi:10.3389/fpsyt.2023.1089504.; Kern DM, Cepeda MS, Defalco F, Etropolski M. Treatment patterns and sequences of pharmacotherapy for patients diagnosed with depression in the United States: 2014 through 2019. BMC Psychiatry. 2020;20(1):4. doi:10.1186/s12888‐019‐2418‐7.; Hripcsak G, Ryan PB, Duke JD, et al. Characterizing treatment pathways at scale using the OHDSI network. Proc Natl Acad Sci U S A. 2016;113(27):7329‐7336. doi:10.1073/pnas.1510502113.; Gauthier G, Guérin A, Zhdanava M, et al. Treatment patterns, healthcare resource utilization, and costs following first‐line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis. BMC Psychiatry. 2017;17(1):222. doi:10.1186/s12888‐017‐1385‐0.; Seifert J, Maier HB, Führmann F, et al. Pharmacological treatment of major depressive disorder according to severity in psychiatric inpatients: results from the AMSP pharmacovigilance program from 2001–2017. J Neural Transm (Vienna). 2022;129(7):925‐944. doi:10.1007/s00702‐022‐02504‐6.; Jain R, Higa S, Keyloun K, et al. Treatment patterns during major depressive episodes among patients with major depressive disorder: a retrospective database analysis. Drugs Real World Outcomes. 2022;9(3):477‐486. doi:10.1007/s40801‐022‐00316‐4.; Høj Jørgensen TS, Osler M, Jorgensen MB, Jorgensen A. Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish nationwide cohort study using sequence analysis. Lancet Psychiatry. 2023;10(1):12‐20. doi:10.1016/S2215‐0366(22)00367‐4.; Bauer M, Severus E, Köhler S, et al. World Federation of Societies of biological psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders. Part 2: maintenance treatment of major depressive disorder‐update 2015. World J Biol Psychiatry. 2015;16(2):76‐95. doi:10.3109/15622975.2014.1001786.; Bschor T, Kern H, Henssler J, Baethge C. Switching the antidepressant after nonresponse in adults with major depression: a systematic literature search and meta‐analysis. J Clin Psychiatry. 2018;79(1):16r10749. doi:10.4088/JCP.16r10749.; Henssler J, Alexander D, Schwarzer G, Bschor T, Baethge C. Combining antidepressants vs antidepressant monotherapy for treatment of patients with acute depression: a systematic review and meta‐analysis. JAMA Psychiatry. 2022;79(4):300‐312. doi:10.1001/jamapsychiatry.2021.4313.; Carey M, Sanson‐Fisher R, Zwar N, et al. Improving depression outcomes among Australian primary care patients: protocol for a cluster randomised controlled trial. BMJ Open. 2020;10(2):e032057. doi:10.1136/bmjopen‐2019‐032057.; Rink L, Braun C, Bschor T, Henssler J, Franklin J, Baethge C. Dose increase versus unchanged continuation of antidepressants after initial antidepressant treatment failure in patients with major depressive disorder: a systematic review and meta‐analysis of randomized, double‐blind trials. J Clin Psychiatry. 2018;79(3):17r11693. doi:10.4088/JCP.17r11693.; Braun C, Adams A, Rink L, Bschor T, Kuhr K, Baethge C. In search of a dose‐response relationship in SSRIs‐a systematic review, meta‐analysis, and network meta‐analysis. Acta Psychiatr Scand. 2020;142(6):430‐442. doi:10.1111/acps.13235.; Rink L, Adams A, Braun C, Bschor T, Kuhr K, Baethge C. Dose‐response relationship in selective serotonin and norepinephrine reuptake inhibitors in the treatment of major depressive disorder: a meta‐analysis and network meta‐analysis of randomized controlled trials. Psychother Psychosom. 2022;91(2):84‐93. doi:10.1159/000520554.; Undurraga J, Sim K, Tondo L, et al. Lithium treatment for unipolar major depressive disorder: systematic review. J Psychopharmacol. 2019;33(2):167‐176. doi:10.1177/0269881118822161.; Roose SP, Glassman AH, Attia E, Woodring S. Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia. Am J Psychiatry. 1994;151(12):1735‐1739. doi:10.1176/ajp.151.12.1735.; Danish University Antidepressant Group. Citalopram: clinical effect profile in comparison with clomipramine. A controlled multicenter study. Danish university antidepressant group. Psychopharmacology. 1986;90(1):131‐138. doi:10.1007/BF00172884.; Danish University Antidepressant Group. Paroxetine: a selective serotonin reuptake inhibitor showing better tolerance, but weaker antidepressant effect than clomipramine in a controlled multicenter study. Danish university antidepressant group. J Affect Disord. 1990;18(4):289‐299. doi:10.1016/0165‐0327(90)90081‐i.; Geddes JR, Freemantle N, Mason J, Eccles MP, Boynton J. SSRIs versus other antidepressants for depressive disorder. Cochrane Database Syst Rev. 2000;(2):CD001851. doi:10.1002/14651858.CD001851.; Spoelma MJ, Serafimovska A, Parker G. Differentiating melancholic and non‐melancholic depression via biological markers: a review. World J Biol Psychiatry. 2023;1‐50. doi:10.1080/15622975.2023.2219725.; Pain O, Hodgson K, Trubetskoy V, et al. Identifying the common genetic basis of antidepressant response. Biol Psychiatry Global Open Sci. 2022;2(2):115‐126. doi:10.1016/j.bpsgos.2021.07.008.; Clements CC, Karlsson R, Lu Y, et al. Genome‐wide association study of patients with a severe major depressive episode treated with electroconvulsive therapy. Mol Psychiatry. 2021;26(6):2429‐2439. doi:10.1038/s41380‐020‐00984‐0.; Chekroud AM, Bondar J, Delgadillo J, et al. The promise of machine learning in predicting treatment outcomes in psychiatry. World Psychiatry. 2021;20(2):154‐170. doi:10.1002/wps.20882.; Adli M, Wiethoff K, Baghai TC, et al. How effective is algorithm‐guided treatment for depressed inpatients? Results from the randomized controlled multicenter German algorithm project 3 trial. Int J Neuropsychopharmacol. 2017;20(9):721‐730. doi:10.1093/ijnp/pyx043. |
| Grant Information: | Bispebjerg Hospital; Jascha Fonden; Region Hovedstadens Psykiatri |
| Contributed Indexing: | Keywords: antidepressants; antipsychotics; lithium; prescription patterns; unipolar depression |
| Substance Nomenclature: | 0 (Antidepressive Agents); 0 (Selective Serotonin Reuptake Inhibitors) |
| Entry Date(s): | Date Created: 20231122 Date Completed: 20240116 Latest Revision: 20250703 |
| Update Code: | 20260130 |
| DOI: | 10.1111/acps.13640 |
| PMID: | 37990476 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't