Relationship Between Patient Characteristics, Patterns of Treatment, and Medication Adherence Among Individuals with Major Depressive Disorder

Abstract: Background: Major depressive disorder (MDD) is associated with elevated health care and societal cost, increased morbidity and mortality, and diminished quality of life. First line treatments include pharmacotherapy and psychotherapy. However, little is known about patient characteristics associated with treatment choice (including monotherapy and adjunctive therapy), adherence to treatment, and outcomes. Objectives: To better understand treatment choice and outcomes associated with different approaches to treatment for MDD. Methods: A retrospective analysis using claims data (2016-2019) from Clarivate, individuals who had either an eligible antidepressant therapy (ADT) or psychotherapy claim after MDD diagnosis were stratified into two cohorts based on initial treatment approach (i.e., pharmacotherapy or psychotherapy). Demographics, comorbidities, and treatment response in the 12-month follow up period were compared between groups. Results: Of the 316,709 MDD patients, 146,209 initiated pharmacotherapy and 170,500 psychotherapy. Compared to the psychotherapy group, the pharmacotherapy group was slightly less likely female (73.7% vs 74.7%), slightly older (42.2 vs 40.9 years), less likely commercially insured (37.6% vs 42.5%) and more likely Medicaid (54.4% vs 50.3%), less likely to have bipolar disorder (3.0% vs 4.3%), and had a higher Elixhauser Comorbidity Index (-1.76 vs -2.96) (all pShort Description: This study adds to our knowledge about patterns of treatment for MDD. Individuals were stratified into two cohorts based on index treatment (pharmacotherapy or psychotherapy). Treatment response was measured using indicators of discontinuation, adherence, switching, and augmentation (with pharmacotherapy or psychotherapy) following a period of monotherapy. The rate of medication and psychotherapy discontinuation was high, however, when psychotherapy was combined with pharmacotherapy, there was a slight improvement in persistence.Name of Sponsoring Organization(s): Orexo US, Inc