The sociodemographic and clinical profile of patients with major depressive disorder receiving SSRIs as first-line antidepressant treatment in European countries

Abstract

Introduction Due to favorable antidepressant (AD) efficacy and tolerability, selective-serotonin reuptake inhibitors (SSRIs) are consistently recommended as substances of first choice for the treatment of major depressive disorder (MDD) in international guidelines. However, little is known about the real-world clinical correlates of patients primarily prescribed SSRIs in contrast to those receiving alternative first-line ADs. Methods These secondary analyses are based on a naturalistic, multinational cross-sectional study conducted by the European Group for the Study of Resistant Depression at ten research sites. We compared the socio-demographic and clinical characteristics of 1410 patients with primary MDD, who were either prescribed SSRIs or alternative substances as first-line AD treatment, using chi-squared tests, analyses of covariance, and logistic regression analyses. Results SSRIs were prescribed in 52.1% of MDD patients who showed lower odds for unemployment, current severity of depressive symptoms, melancholic features, suicidality, as well as current inpatient treatment compared to patients receiving alternative first-line ADs. Furthermore, patients prescribed SSRIs less likely received add-on therapies including AD combination and augmentation with antipsychotics, and exhibited a trend towards higher response rates. Conclusion A more favorable socio-demographic and clinical profile associated with SSRIs in contrast to alternative first-line ADs may have guided European psychiatrists’ treatment choice for SSRIs, rather than any relevant pharmacological differences in mechanisms of action of the investigated ADs. Our results must be cautiously interpreted in light of predictable biases resulting from the open treatment selection, the possible allocation of less severely ill patients to SSRIs as well as the cross-sectional study design that does not allow to ascertain any causal conclusions.

The Toxicity Potential of Antidepressants and Antipsychotics in Relation to Other Medication and Alcohol: A Naturalistic and Retrospective Study

“…Although morbidity and mortality associated with ADs, APs, and other psychopharmacotherapeutics remain frequent subjects of scientific discourse ( 53 ), the present study corroborates the relative safety of AD/AP medication even in patients at increased risk for suicidality. It, therefore, supports the adequate use of these drugs in this vulnerable patient group, even more so since it was repeatedly shown to reduce suicidality ( 1 , 2 , 43 ). In emergency settings, the potential stigmatization of patients suffering from psychiatric disorders should be considered, focusing on potentially underdiagnosed psychiatric comorbidities.…”

“…It is noteworthy in this context that no patient investigated in our study suffered from intoxication with tricyclic ADs (TCAs). This might be explained by the fact that the prescriptions of TCAs generally decreased due to the increasing use of modern ADs such as SSRIs, which are equally effective, much better tolerated, and recommended as first-line treatment ( 2 , 43 , 44 ).…”

“…Correspondingly, international evidence shows that being diagnosed with a psychiatric disorder is associated with a higher risk for suicide attempts ( 1 , 35 ). Furthermore, such associations, including rates for completed suicide, were prominent in patients treated with TCAs, representing older AD substances that were largely replaced by newer AD substances such as SSRIs and SNRIs ( 43 , 48 ) due to their beneficial side effect profile ( 21 , 49 ), especially in terms of QTc prolongation ( 25 , 44 ). Although international treatment guidelines recommend the employment of SSRIs and SNRIs as first-line AD treatment ( 2 ), heterogeneous prescription and suicide rates identified in international samples may additionally reflect the varying quality and access of mental health care ( 50 ).…”

Impulsivity across severe mental disorders: a cross-sectional study of immune markers and psychopharmacotherapy

“…This association might reflect a causal effect of antidepressants on impulsivity or a more intensive antidepressant prescription practice in impulsive patient populations. Indeed, clinical characteristics have been suggested to affect the antidepressant prescription practice, with deflections from the standard first-line treatment of major depressive disorder in more severely ill patient populations at higher suicide risk [ 64 ]. A large register-based observational study has shown an increased risk of suicide attempt repetition in individuals prescribed antidepressants, which was not apparent after accounting for the baseline risk of suicide attempt repetition [ 65 ].…”

Assessing Pharmacokinetic Correlates of Escitalopram-Related Adverse Drug Reactions

“…Escitalopram (ESC), the active S-(+)-enantiomer of citalopram, is a selective serotonin reuptake inhibitor used as a first-line treatment for major depressive disorder (MDD) 1 and generalized anxiety disorder. 2 It is the most commonly prescribed antidepressant in the United States.…”