Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration

• Published in: Clinical therapeutics 2010-11, Vol.32 (12), p.2057-2072
• Main Authors: Milea, Dominique, PharmD, MSc, Guelfucci, Florent, MSc, Bent-Ennakhil, Nawal, MSc, Toumi, Mondher, MD, PhD, Auray, Jean-Paul, PhD
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Antidepressants; Antidepressive Agents, Tricyclic - administration & dosage; Antidepressive Agents, Tricyclic - therapeutic use; Biological and medical sciences; claims database; combination; Costs; Databases, Factual; Depression; Depression - drug therapy; Depression - prevention & control; Depression - psychology; Drug Administration Schedule; Drug therapy; Drug Therapy, Combination; Female; Humans; Internal Medicine; Male; Medical Education; Medical sciences; Medicare; Medication Adherence; Mental depression; Middle Aged; Mood disorders; Patients; Pharmacology. Drug treatments; Pharmacy; Primary care; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Secondary Prevention; Serotonin; Serotonin Uptake Inhibitors - administration & dosage; Serotonin Uptake Inhibitors - therapeutic use; Survival analysis; switching; Time Factors
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2010.11.011

Abstract Background: The basic principles of pharmacotherapy for depression are consistent among most US and western European guidelines. All recommend ≥6 months of antidepressant therapy and propose several alternatives in cases of inappropriate response. Objectives: The aims of this analysis were to describe antidepressant treatment changes and treatment duration in patients undergoing treatment for a new episode of depression and to identify risk factors for treatment changes and treatment discontinuation. Methods: For this claims database analysis, adults and children treated with antidepressants for a new episode of depression in the time period from 2004 to 2006 were identified using the IMS LifeLink Health Plan Database. Treatment changes (defined as switches to an antidepressant or antipsychotic; combination with an antidepressant; or augmentation with lithium, an anticonvulsant, or an atypical antipsychotic) were described. Antidepressant treatment duration was assessed and described per treatment change. Risk factors for treatment change or discontinuation were identified using multivariate logistic regression (treatment change) or Cox regression (treatment duration). Results: Of 134,287 patients identified using the database (mean [SD] age, 39.1 [14.9] years; 68.1% women), 31,123 (23.2%) had a treatment change, most commonly an antidepressant switch (12,735 [9.5%]) or combination (12,214 [9.1%]). Antipsychotics were introduced in