Times to Discontinue Antidepressants Over 6 Months in Patients with Major Depressive Disorder

Jung, Woo Young; Jang, Sae Heon; Kim, Sung Gon; Jae, Young Myo; Kong, Bo Hyun; Kim, Ho-Chan; Choe, Byeong Moo; Kim, Jeong Gee; Kim, Choong Rak

doi:10.4306/pi.2016.13.4.440

Cited by 18 publications

(21 citation statements)

References 35 publications

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“…The high rate of discontinuation in our study is consistent with the high discontinuation rate reported in a recent study by Jung et al [ 24 ]. In this study, over 70% of patients discontinued antidepressants after 6 months (including patients who switched).…”

Section: Discussionsupporting

confidence: 93%

Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis

et al. 2017

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BackgroundAlthough the symptoms of major depressive disorder (MDD) are often manageable with pharmacotherapy, response to first-line antidepressant treatment is often less than optimal. This study describes long-term treatment patterns in MDD patients in the United States and quantifies the economic burden associated with different treatment patterns following first-line antidepressant therapy.MethodsMDD patients starting first-line antidepressant monotherapy and having continuous enrollment ≥12 months before and ≥24 months following the index date (i.e., the first documented prescription fill) were selected from the Truven Health Analytics MarketScan (2003–2014) database. Based on the type of first treatment change following initiation, six treatment cohorts were defined a priori (“persistence”; “discontinuation”; “switch”; “dose escalation”; “augmentation”; and “combination”). Treatment patterns through the fourth line of therapy within each cohort, healthcare resource utilization (HCRU), and cost analyses were restricted to patients with adequate treatment duration (defined as ≥42 days) in each line (analysis sub-sample, N = 21,088). HCRU and costs were described at the cohort and pattern levels. Treatment cohorts representing <5% of the analysis sub-sample were decided a priori not to be analyzed due to limited sample size.Results39,557 patients were included. Mean age was 42.1 years, 61.1% of patients were female, and mean follow-up was 4.1 years. Among the analysis sub-sample, the discontinuation (49.1%), dose escalation (37.4%), and switch (6.6%) cohorts were the most common of all treatment cohorts. First-line antidepressant discontinuation without subsequent MDD pharmacotherapy (22.9%) and cycling between discontinuation and resumption (11.2%) were the two most common treatment patterns. Median time to discontinuation was 23 weeks. The switch cohort exhibited the highest HCRU (18.9 days with medical visits per-patient-per-year) and greatest healthcare costs ($11,107 per-patient-per-year) following the index date. Treatment patterns representing a cycling on and off treatment in the switch cohort were associated with the greatest healthcare costs overall.ConclusionA high proportion of patients discontinue first-line antidepressant shortly after initiation. Patterns representing a cycling on and off treatment in the switch cohort were associated with the highest healthcare costs. These findings underscore challenges in effectively treating patients with MDD and a need for personalized patient management.

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Section: Discussionsupporting

confidence: 93%

Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis

et al. 2017

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“…По эпидемиологическим данным, только у 40-50% пациентов имеется клинический ответ на принимаемый антидепрессант [7]. Согласно руководству терапии аффективных расстройств, длительность приема антидепрессантов должна составлять не ме-нее 1 года [7,10]. При этом пациенты могут длительное время принимать назначенный им препарат, однако, его эффект может быть незначительным или вообще отсутствовать.…”

Section: Using the Quantitative Eeg Methods In Predicting The Responseunclassified

Using the quantitative EEG method in predicting the response to treatment of affective disorders

Галкин¹,

Васильева²,

Симуткин³

et al. 2020

V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY

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The aim is to study the features of brain activity in patients with affective disorders, depending on the response to therapy. Material and methods. The study included 84 patients with affective disorder. All patients received syndrome-induced psychopharmacotherapy, which included antidepressants and normotimic drugs. The severity of affective disorder was assessed using the Hamilton depression scale. The criterion for the effectiveness of therapy (sensitivity) was an improvement in clinical symptoms by 50% or more, estimated using the Hamilton scale. The study was performed in two stages (points): at the first point, patients were examined upon admission to the Department before taking medications (electroencephalogram recording and filling in the Hamilton scale were performed), the second point was performed after a 4-week course of treatment of patients in the hospital (filling in the Hamilton scale). Registration and analysis of bioelectric activity of the brain was carried out using a 16-channel encephalograph. The signals were processed using fastFourier transform, and the values of absolute spectral power (mV2) for θ — (4 — 7 Hz), α — (8 — 13 Hz) and β — (14 — 30 Hz) rhythms were analyzed.Results. Analysis of the spectral power of electroencephalographic rhythms at rest with closed eyes showed statistically significantly higher values of alpha-rhythm in the frontal(p=0.044) and parietal (0.049) cortex, beta-rhythm in the frontal cortex (p=0.048) and theta-rhythm in the frontal (p=0.0004), Central (p=0.009), parietal (p=0.003) and occipital (p=0.001) cortex in patients who were not sensitive to therapy for compared to respondents.Conclusion. Our study revealed significant differences in quantitative electroencephalogram parameters between patients with affective disorders, depending on the sensitivity to the therapy. The results show that there are aspects of quantitative electroencephalogram thatare related to the response to pharmacological treatment of affective disorders.

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“…Before the patient is “labeled” treatment-resistant, an attempt to optimize the IAD trial is essential by ensuring that the maximum recommended dose for the recommended duration has been used. A trial duration of approximately 4 to 6 weeks is recommended by most of the guidelines for the treatment of depression [ 12 , 13 ]. Results from the sequenced treatment alternatives to relieve depression (STAR*D) trial indicated that a longer trial period may be required for treated patients to develop the full therapeutic potential of the intervention.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, median time, and associated factors with the likelihood of initial antidepressant change: a cross-sectional study in Qatar

et al. 2021

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Background Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. Methods This was a retrospective study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using several cox regression models. Results A total of 487 patients met the inclusion criteria of the study, 431 (88%) of them had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. The factors statistically associated with higher hazard of IAD change were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Conclusions Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. Our findings offered some clues to help clinicians identify the high-risk predictors of short survival and subsequent failure of IAD.

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Times to Discontinue Antidepressants Over 6 Months in Patients with Major Depressive Disorder

Cited by 18 publications

References 35 publications

Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis

Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis

Using the quantitative EEG method in predicting the response to treatment of affective disorders

Prevalence, median time, and associated factors with the likelihood of initial antidepressant change: a cross-sectional study in Qatar

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