Treatment Patterns for Depressive Episodes May Signal Poor Care Personalization

SAN DIEGO—Clinicians tend to decrease monotherapy and increase adjunctive therapy when patients with major depressive disorder experience major depressive episodes, according to research presented at Psych Congress 2019.

“Many major depressive disorder patients fail to achieve remission,” wrote poster presenter Patrick Gillard, Pharm D, and coauthors. “Current literature focuses on one major depressive episode; treatment over multiple major depressive episodes has not been extensively explored.”

With this study, researchers aimed to characterize treatment patterns within and across multiple major depressive episodes. Using IBM MarketScan Commercial databases, they identified 455,082 adults with major depressive disorder and evaluated 12 months or more of follow-up data for each patient.

Some 12% of the patients experienced multiple major depressive episodes, the study found.

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Within the first major depressive episode, monotherapy regimens dropped from 100% to 58% by the fourth line of therapy, researchers reported, and adjunctive therapy rose from 0% to 42%. Subsequent major depressive episodes showed a similar trend.

Across episodes, more than half of patients failed treatment (defined as discontinuation, switching, adding an adjunctive therapy, or changing an adjunctive therapy) in each line of therapy, with higher rates of discontinuation and lower rates of switching in earlier lines of therapy. The exception was the first line of therapy during the first major depressive episode, which was characterized by less discontinuation and more switching.

“Results suggest that treatment failure patterns are consistent across major depressive episodes and may indicate suboptimal personalized care,” researchers wrote.

Allergan sponsored the study.

—Jolynn Tumolo

Reference

Gillard P, Higa S, Jain R, et al. Treatment patterns among MDD patients during major depressive episodes. Poster presented at Psych Congress 2019; October 3-6, 2019; San Diego, CA. Poster 142.