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Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration
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...
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| Published in: | Clinical therapeutics 2010-11, Vol.32 (12), p.2057-2072 |
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| container_end_page | 2072 |
| container_issue | 12 |
| container_start_page | 2057 |
| container_title | Clinical therapeutics |
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| creator | Milea, Dominique, PharmD, MSc Guelfucci, Florent, MSc Bent-Ennakhil, Nawal, MSc Toumi, Mondher, MD, PhD Auray, Jean-Paul, PhD |
| description | 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 |
| doi_str_mv | 10.1016/j.clinthera.2010.11.011 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_815553234</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0149291810003735</els_id><sourcerecordid>2734241701</sourcerecordid><originalsourceid>FETCH-LOGICAL-c483t-dde1215bd6a8206461564f0a8c9f59fa29df169ca0c039b06ac39310b18685673</originalsourceid><addsrcrecordid>eNqNkk2LFDEQhhtR3NnVv6ANInvqMZV0ejoehGHxCxY8qOAtVCfVbsb-GFPdwvx70864K3vyFKg89dbHW1n2HMQaBFSvdmvXhWG6oYhrKZYorAXAg2wF9cYUAOW3h9lKQGkKaaA-y86Zd0IIZbR8nJ1JgMSVcpU122EKnvaRmHGY8n4cxj-y-8PrfJu7DkPPuccJG2TKccDuwIHzsc2nSDj1lJLcDQ7fidOv_yfq54hTGIcn2aMWO6anp_ci-_ru7ZerD8X1p_cfr7bXhStrNRXeE0jQja-wlqIqK9BV2QqsnWm1aVEa30JlHAqXxmhEhU4ZBaKBuqp1tVEX2eVRdx_HnzPxZPvAjroOBxpntjVorZVUZSJf3CN34xzTaGxBKAXalLpO1OZIuTgyR2rtPoYe4yFBdnHB7uytC3ZxwQLY5ELKfHbSn5ue_G3e37Un4OUJQHbYtREHF_iOUxWYWi4tbI8cpb39ChQtu0CDIx8iucn6MfxHM2_uaSxcSGV_0IH4bnLL0gr7eTma5WZgOZeN0uo3RR--nQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1033159458</pqid></control><display><type>article</type><title>Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration</title><source>ScienceDirect Freedom Collection 2022-2024</source><creator>Milea, Dominique, PharmD, MSc ; Guelfucci, Florent, MSc ; Bent-Ennakhil, Nawal, MSc ; Toumi, Mondher, MD, PhD ; Auray, Jean-Paul, PhD</creator><creatorcontrib>Milea, Dominique, PharmD, MSc ; Guelfucci, Florent, MSc ; Bent-Ennakhil, Nawal, MSc ; Toumi, Mondher, MD, PhD ; Auray, Jean-Paul, PhD</creatorcontrib><description>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 <5% of patients. The median overall treatment duration (111 days) was shorter than that recommended in the guidelines (≥6 months). Index antidepressant class was significantly associated with treatment change (higher for tricyclic antidepressants [TCAs] [odds ratio (OR) = 1.59 (95% CI, 1.48–1.70)]; lower for selective serotonin reuptake inhibitors [OR = 0.87 (95% CI, 0.84–0.91)]) and duration (increased risk for early discontinuation for TCAs [hazard ratio (HR) = 1.36 (95% CI, 1.30–1.44)]; lower risk for late discontinuation for serotonin-norepinephrine reuptake inhibitors [HR = 0.81 (95% CI, 0.79–0.84)]). Indicators of depression severity or complexity (prescription by a mental health specialist, previous use of psychotropics, previous psychiatric hospitalization, and presence of psychosomatic comorbidities) were associated with a higher risk for treatment change and inconsistently associated with treatment duration. Two health plans were associated with increased risk for discontinuation (Medicaid, HR = 1.35 [95% CI, 1.28–1.42]; Medicare, HR = 1.38 [95% CI, 1.12–1.71]). Combination and augmentation strategies were associated with a lower risk for treatment discontinuation (combination, HR = 0.83 [95% CI, 0.81–0.86]; augmentation, HR = 0.75 [95% CI, 0.73–0.77]). Overall treatment duration was <30 days in 31,177 patients (26.2%) and >6 months in 54,502 (37.5%). Conclusions: In this claims database analysis, changes in antidepressant treatment involved 23.2% of patients. The median overall treatment duration was shorter than recommended by guidelines due to a quarter of patients having early treatment discontinuation.</description><identifier>ISSN: 0149-2918</identifier><identifier>EISSN: 1879-114X</identifier><identifier>DOI: 10.1016/j.clinthera.2010.11.011</identifier><identifier>PMID: 21118742</identifier><language>eng</language><publisher>Bridgewater, NJ: EM Inc USA</publisher><subject>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</subject><ispartof>Clinical therapeutics, 2010-11, Vol.32 (12), p.2057-2072</ispartof><rights>Elsevier HS Journals, Inc.</rights><rights>2010 Elsevier HS Journals, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-dde1215bd6a8206461564f0a8c9f59fa29df169ca0c039b06ac39310b18685673</citedby><cites>FETCH-LOGICAL-c483t-dde1215bd6a8206461564f0a8c9f59fa29df169ca0c039b06ac39310b18685673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23619828$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21118742$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Milea, Dominique, PharmD, MSc</creatorcontrib><creatorcontrib>Guelfucci, Florent, MSc</creatorcontrib><creatorcontrib>Bent-Ennakhil, Nawal, MSc</creatorcontrib><creatorcontrib>Toumi, Mondher, MD, PhD</creatorcontrib><creatorcontrib>Auray, Jean-Paul, PhD</creatorcontrib><title>Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration</title><title>Clinical therapeutics</title><addtitle>Clin Ther</addtitle><description>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 <5% of patients. The median overall treatment duration (111 days) was shorter than that recommended in the guidelines (≥6 months). Index antidepressant class was significantly associated with treatment change (higher for tricyclic antidepressants [TCAs] [odds ratio (OR) = 1.59 (95% CI, 1.48–1.70)]; lower for selective serotonin reuptake inhibitors [OR = 0.87 (95% CI, 0.84–0.91)]) and duration (increased risk for early discontinuation for TCAs [hazard ratio (HR) = 1.36 (95% CI, 1.30–1.44)]; lower risk for late discontinuation for serotonin-norepinephrine reuptake inhibitors [HR = 0.81 (95% CI, 0.79–0.84)]). Indicators of depression severity or complexity (prescription by a mental health specialist, previous use of psychotropics, previous psychiatric hospitalization, and presence of psychosomatic comorbidities) were associated with a higher risk for treatment change and inconsistently associated with treatment duration. Two health plans were associated with increased risk for discontinuation (Medicaid, HR = 1.35 [95% CI, 1.28–1.42]; Medicare, HR = 1.38 [95% CI, 1.12–1.71]). Combination and augmentation strategies were associated with a lower risk for treatment discontinuation (combination, HR = 0.83 [95% CI, 0.81–0.86]; augmentation, HR = 0.75 [95% CI, 0.73–0.77]). Overall treatment duration was <30 days in 31,177 patients (26.2%) and >6 months in 54,502 (37.5%). Conclusions: In this claims database analysis, changes in antidepressant treatment involved 23.2% of patients. The median overall treatment duration was shorter than recommended by guidelines due to a quarter of patients having early treatment discontinuation.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antidepressants</subject><subject>Antidepressive Agents, Tricyclic - administration & dosage</subject><subject>Antidepressive Agents, Tricyclic - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>claims database</subject><subject>combination</subject><subject>Costs</subject><subject>Databases, Factual</subject><subject>Depression</subject><subject>Depression - drug therapy</subject><subject>Depression - prevention & control</subject><subject>Depression - psychology</subject><subject>Drug Administration Schedule</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical Education</subject><subject>Medical sciences</subject><subject>Medicare</subject><subject>Medication Adherence</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Mood disorders</subject><subject>Patients</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacy</subject><subject>Primary care</subject><subject>Psychiatry</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Retrospective Studies</subject><subject>Secondary Prevention</subject><subject>Serotonin</subject><subject>Serotonin Uptake Inhibitors - administration & dosage</subject><subject>Serotonin Uptake Inhibitors - therapeutic use</subject><subject>Survival analysis</subject><subject>switching</subject><subject>Time Factors</subject><issn>0149-2918</issn><issn>1879-114X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNqNkk2LFDEQhhtR3NnVv6ANInvqMZV0ejoehGHxCxY8qOAtVCfVbsb-GFPdwvx70864K3vyFKg89dbHW1n2HMQaBFSvdmvXhWG6oYhrKZYorAXAg2wF9cYUAOW3h9lKQGkKaaA-y86Zd0IIZbR8nJ1JgMSVcpU122EKnvaRmHGY8n4cxj-y-8PrfJu7DkPPuccJG2TKccDuwIHzsc2nSDj1lJLcDQ7fidOv_yfq54hTGIcn2aMWO6anp_ci-_ru7ZerD8X1p_cfr7bXhStrNRXeE0jQja-wlqIqK9BV2QqsnWm1aVEa30JlHAqXxmhEhU4ZBaKBuqp1tVEX2eVRdx_HnzPxZPvAjroOBxpntjVorZVUZSJf3CN34xzTaGxBKAXalLpO1OZIuTgyR2rtPoYe4yFBdnHB7uytC3ZxwQLY5ELKfHbSn5ue_G3e37Un4OUJQHbYtREHF_iOUxWYWi4tbI8cpb39ChQtu0CDIx8iucn6MfxHM2_uaSxcSGV_0IH4bnLL0gr7eTma5WZgOZeN0uo3RR--nQ</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>Milea, Dominique, PharmD, MSc</creator><creator>Guelfucci, Florent, MSc</creator><creator>Bent-Ennakhil, Nawal, MSc</creator><creator>Toumi, Mondher, MD, PhD</creator><creator>Auray, Jean-Paul, PhD</creator><general>EM Inc USA</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20101101</creationdate><title>Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration</title><author>Milea, Dominique, PharmD, MSc ; Guelfucci, Florent, MSc ; Bent-Ennakhil, Nawal, MSc ; Toumi, Mondher, MD, PhD ; Auray, Jean-Paul, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-dde1215bd6a8206461564f0a8c9f59fa29df169ca0c039b06ac39310b18685673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antidepressants</topic><topic>Antidepressive Agents, Tricyclic - administration & dosage</topic><topic>Antidepressive Agents, Tricyclic - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>claims database</topic><topic>combination</topic><topic>Costs</topic><topic>Databases, Factual</topic><topic>Depression</topic><topic>Depression - drug therapy</topic><topic>Depression - prevention & control</topic><topic>Depression - psychology</topic><topic>Drug Administration Schedule</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical Education</topic><topic>Medical sciences</topic><topic>Medicare</topic><topic>Medication Adherence</topic><topic>Mental depression</topic><topic>Middle Aged</topic><topic>Mood disorders</topic><topic>Patients</topic><topic>Pharmacology. Drug treatments</topic><topic>Pharmacy</topic><topic>Primary care</topic><topic>Psychiatry</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Retrospective Studies</topic><topic>Secondary Prevention</topic><topic>Serotonin</topic><topic>Serotonin Uptake Inhibitors - administration & dosage</topic><topic>Serotonin Uptake Inhibitors - therapeutic use</topic><topic>Survival analysis</topic><topic>switching</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Milea, Dominique, PharmD, MSc</creatorcontrib><creatorcontrib>Guelfucci, Florent, MSc</creatorcontrib><creatorcontrib>Bent-Ennakhil, Nawal, MSc</creatorcontrib><creatorcontrib>Toumi, Mondher, MD, PhD</creatorcontrib><creatorcontrib>Auray, Jean-Paul, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest_Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Milea, Dominique, PharmD, MSc</au><au>Guelfucci, Florent, MSc</au><au>Bent-Ennakhil, Nawal, MSc</au><au>Toumi, Mondher, MD, PhD</au><au>Auray, Jean-Paul, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration</atitle><jtitle>Clinical therapeutics</jtitle><addtitle>Clin Ther</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>32</volume><issue>12</issue><spage>2057</spage><epage>2072</epage><pages>2057-2072</pages><issn>0149-2918</issn><eissn>1879-114X</eissn><abstract>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 <5% of patients. The median overall treatment duration (111 days) was shorter than that recommended in the guidelines (≥6 months). Index antidepressant class was significantly associated with treatment change (higher for tricyclic antidepressants [TCAs] [odds ratio (OR) = 1.59 (95% CI, 1.48–1.70)]; lower for selective serotonin reuptake inhibitors [OR = 0.87 (95% CI, 0.84–0.91)]) and duration (increased risk for early discontinuation for TCAs [hazard ratio (HR) = 1.36 (95% CI, 1.30–1.44)]; lower risk for late discontinuation for serotonin-norepinephrine reuptake inhibitors [HR = 0.81 (95% CI, 0.79–0.84)]). Indicators of depression severity or complexity (prescription by a mental health specialist, previous use of psychotropics, previous psychiatric hospitalization, and presence of psychosomatic comorbidities) were associated with a higher risk for treatment change and inconsistently associated with treatment duration. Two health plans were associated with increased risk for discontinuation (Medicaid, HR = 1.35 [95% CI, 1.28–1.42]; Medicare, HR = 1.38 [95% CI, 1.12–1.71]). Combination and augmentation strategies were associated with a lower risk for treatment discontinuation (combination, HR = 0.83 [95% CI, 0.81–0.86]; augmentation, HR = 0.75 [95% CI, 0.73–0.77]). Overall treatment duration was <30 days in 31,177 patients (26.2%) and >6 months in 54,502 (37.5%). Conclusions: In this claims database analysis, changes in antidepressant treatment involved 23.2% of patients. The median overall treatment duration was shorter than recommended by guidelines due to a quarter of patients having early treatment discontinuation.</abstract><cop>Bridgewater, NJ</cop><pub>EM Inc USA</pub><pmid>21118742</pmid><doi>10.1016/j.clinthera.2010.11.011</doi><tpages>16</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0149-2918 |
| ispartof | Clinical therapeutics, 2010-11, Vol.32 (12), p.2057-2072 |
| issn | 0149-2918 1879-114X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_815553234 |
| source | ScienceDirect Freedom Collection 2022-2024 |
| 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 |
| title | Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T05%3A53%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Antidepressant%20monotherapy:%20A%20claims%20database%20analysis%20of%20treatment%20changes%20and%20treatment%20duration&rft.jtitle=Clinical%20therapeutics&rft.au=Milea,%20Dominique,%20PharmD,%20MSc&rft.date=2010-11-01&rft.volume=32&rft.issue=12&rft.spage=2057&rft.epage=2072&rft.pages=2057-2072&rft.issn=0149-2918&rft.eissn=1879-114X&rft_id=info:doi/10.1016/j.clinthera.2010.11.011&rft_dat=%3Cproquest_cross%3E2734241701%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c483t-dde1215bd6a8206461564f0a8c9f59fa29df169ca0c039b06ac39310b18685673%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1033159458&rft_id=info:pmid/21118742&rfr_iscdi=true |