Using filled prescription sequences to rank antidepressants according to their acceptability in the general population: The Constances cohort.

Ranking antidepressants according to their acceptability (i.e. a combination of both efficacy and tolerability) in the general population may help choosing the best first-line medication. This study aimed to rank antidepressants according to the proportion of filled prescription sequences consistent with a continuation of the first treatment versus those consistent with a change. A first step was validating this measure as a proxy of acceptability by examining the association of these two kinds of sequences with levels of depressive symptoms. Among 64,467 individuals included in the French population-based Constances cohort, reimbursements of antidepressants from January 2009 to December 2015 were extracted from the French national health insurance system claims database. Depressive symptoms were measured at inclusion with the Center for Epidemiologic Studies-Depression scale (CES-D). Between January 2010 and December 2015, 6675 participants newly initiated an antidepressant (34.5% men, mean (SD) age: 48.3 (12.1) years). Among the subsample of participants included during the six-month period following treatment initiation, individuals with continuation sequences had lower levels of depressive symptoms than those with change sequences (mean (SE) CES-D score: 18.9 (0.8) versus 26.5 (2.1), p < 0.001). According to the continuation/change ratio observed over this six-month period in all participants, escitalopram ranked first, followed by sertraline, venlafaxine, citalopram, fluoxetine and paroxetine. In an independent replication sample representative of the French national population, the same six medications ranked first, with escitalopram remaining in first place. The proportion of filled prescription sequences consistent with a continuation versus a change of the first prescribed treatment may provide a widely available measure of antidepressant acceptability in community practice.

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Déclaration de conflit d'intérêts

Declaration of competing interest Dr. Hoertel reports personal fees and non-financial support from Lundbeck, non-financial support from Otsuka, outside the submitted work. Dr. Limosin reports personal fees from Lundbeck, personal fees from Servier, personal fees from Janssen-Cilag, outside the submitted work; Dr. Olfson reports personal fees from Lundbeck, outside the submitted work; Carlos Blanco holds stock in Sanofi, Eli Lilly and General Electric, outside the submitted work; Dr. Fossati has received personal fees and non-financial support from Lundbeck and personal fees from Servier. Dr. Haffen reports personal fees and non-financial support from Lundbeck, personal fees and non-financial support from Janssen-Cilag, personal fees and non-financial support from Otsuka, personal fees and non-financial support from Servier, non-financial support frim Livanova, outside the submitted work; Dr. Lemogne reports personal fees and non-financial support from Boehringer Ingelheim, personal fees from Janssen-Cilag, personal fees and non-financial support from Lundbeck, personal fees and non-financial support from Otsuka, outside the submitted work. Mr. Olekhnovitch, Dr. Fagot-Campagna, Dr. Goldberg and Dr. Zins have nothing to disclose.