Investigation of the pharmacological treatment patterns of Chinese patients with major depressive disorder under real-world settings using multi-channel sequence analysis

Abstract

BackgroundDespite many treatment guidelines available now, the treatment patterns of major depressive disorder (MDD) in China haven't been well-understood due to complexity and diversity.AimTo describe pharmacological treatment patterns of MDD patients in real-world settings using electronic health records from a major psychiatric hospital in China.MethodsMDD patients (18–65 years, ICD-10: F32.x, F33.x) newly initiated single antidepressant (AD) in 2015 were enrolled, the date of first AD prescription during the study period was defined as index date, and eligible patients were followed up to 1 year. Treatment patterns were revealed and analyzed using multi-channel sequence analysis (MCSA), considering patients' chronological sequences (in days) of AD prescription, cumulative treatment step(s), and polypharmacy usage during the follow-up.ResultsThis study (n = 5,003) identified four types of MDD treatment patterns. The first type (1-time treatment) represents the largest proportion of patients (73.6%, n = 3,686), followed by the second type (6-month consistent treatment) and third type (long-term, consistent treatment) collectively accounted for 20.6% (n = 1,031) of patients, by contrast the last type (long-term, inconsistent treatment) made up the rest 5.7% (n = 286) of patients while exhibiting the most complicated treatments patterns. The choice of AD was dominated by selective serotonin reuptake inhibitors (SSRIs), while treatment duration spent in polypharmacy spanned at 2.8%, 16.4%, 2.0%, and 36.5% over the four types, respectively.ConclusionTreatment patterns reflecting real-world pharmacological treatment practices of MDD in China were revealed using MCSA. The observed discrepancies between real-world practice and treatment guidelines provided additional insights in improving the clinical management of MDD.

Prescription patterns in unipolar depression: A nationwide Danish register‐based study of 113,175 individuals followed for 10 years

“…Overall, we found substantial deviation from national and international guidelines, and a large heterogeneity in treatment patterns. Our results corroborate previous studies in the field, [14][15][16][17][18][19] and expand on these by including treatment patterns before diagnosis and outside of hospital settings; by including all patients with unipolar disorder nationwide (thereby avoiding the potential biases introduced by using for example, data from insurance claims databases), and by stratifying for depression severity; the latter only included in an recent inpatient study from Germany. 18 Due to the detailed register-based information on psychiatric diagnoses made before and after the first-time diagnosis of unipolar depression, we were able to perform the study in a population with a highly controlled diagnostic status, which is particularly important due to the high levels of diagnostic instability associated with first-time psychiatric diagnoses 20 and the potential consequent changes to psychopharmacological treatment.…”

“…Fourth, medication prescribed during an inpatient hospitalization is not reported to the national registers and thus constitute a "black box" in the treatment sequences. Fifth, while the results are in accordance with previous studies in the field, [14][15][16][17][18][19] the findings may not be fully generalizable to countries with different health care systems. Sixth, dosing was not included in the analyses.…”