Prospective study of antidepressant treatment of psychiatric patients with depressive disorders: treatment adequacy and outcomes.
Antidepressant
Depression
Psychiatric care
Treatment adequacy
Treatment outcome
Journal
BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559
Informations de publication
Date de publication:
28 Nov 2023
28 Nov 2023
Historique:
received:
15
02
2023
accepted:
21
11
2023
medline:
30
11
2023
pubmed:
29
11
2023
entrez:
29
11
2023
Statut:
epublish
Résumé
Despite numerous national depression care guidelines (DCGs), suboptimal antidepressant treatment may occur. We examined DCG concordance and depression treatment outcomes in psychiatric settings. We evaluated treatment received and outcomes of 128 psychiatric out- and inpatients participating in the PEGAD (Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders) study at baseline, two weeks, and eight weeks using interviews and questionnaires. Inclusion criteria were ICD-10 diagnosis of a depressive disorder, a Patient Health Questionnaire-9 symptom (PHQ-9) score ≥ 10, and a new antidepressant prescribed. The primary outcome of the study was within-individual change in PHQ-9 scores. At baseline, patients had predominately recurrent (83%) and in 19% treatment-resistant depression (TRD). The median preceding duration of the current episode was 6.5 months. At eight weeks, 85% of the patients (n = 107) used a DCG-concordant antidepressant dose. However, due to the scarcity of antidepressant combinations and augmentations, fewer TRD than non-TRD patients (25% vs. 84%, p < 0.005) received adequate antidepressant treatment. Additionally, one-third of the patients received inadequate follow-up. Overall, only 53% received treatment compatible with DCG recommendations for adequate pharmacotherapy and follow-up. The mean decline in PHQ-9 scores (-3.8 ± SD 5.7) was significant (p < 0.0005). Nearly 40% of the patients reached a subthreshold level of depression (PHQ-9 < 10), predicted by a lower baseline PHQ-9 score, recurrent depression, and female sex. However, 45% experienced no significant clinical improvement (PHQ-9 score reduction < 20%). Our findings suggest that inadequate treatment continues to occur in psychiatric care settings, particularly for TRD patients.
Sections du résumé
BACKGROUND
BACKGROUND
Despite numerous national depression care guidelines (DCGs), suboptimal antidepressant treatment may occur. We examined DCG concordance and depression treatment outcomes in psychiatric settings.
METHODS
METHODS
We evaluated treatment received and outcomes of 128 psychiatric out- and inpatients participating in the PEGAD (Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders) study at baseline, two weeks, and eight weeks using interviews and questionnaires. Inclusion criteria were ICD-10 diagnosis of a depressive disorder, a Patient Health Questionnaire-9 symptom (PHQ-9) score ≥ 10, and a new antidepressant prescribed. The primary outcome of the study was within-individual change in PHQ-9 scores.
RESULTS
RESULTS
At baseline, patients had predominately recurrent (83%) and in 19% treatment-resistant depression (TRD). The median preceding duration of the current episode was 6.5 months. At eight weeks, 85% of the patients (n = 107) used a DCG-concordant antidepressant dose. However, due to the scarcity of antidepressant combinations and augmentations, fewer TRD than non-TRD patients (25% vs. 84%, p < 0.005) received adequate antidepressant treatment. Additionally, one-third of the patients received inadequate follow-up. Overall, only 53% received treatment compatible with DCG recommendations for adequate pharmacotherapy and follow-up. The mean decline in PHQ-9 scores (-3.8 ± SD 5.7) was significant (p < 0.0005). Nearly 40% of the patients reached a subthreshold level of depression (PHQ-9 < 10), predicted by a lower baseline PHQ-9 score, recurrent depression, and female sex. However, 45% experienced no significant clinical improvement (PHQ-9 score reduction < 20%).
CONCLUSIONS
CONCLUSIONS
Our findings suggest that inadequate treatment continues to occur in psychiatric care settings, particularly for TRD patients.
Identifiants
pubmed: 38017416
doi: 10.1186/s12888-023-05390-8
pii: 10.1186/s12888-023-05390-8
pmc: PMC10683284
doi:
Substances chimiques
Antidepressive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
888Informations de copyright
© 2023. The Author(s).
Références
Psychiatr Serv. 2011 Feb;62(2):152-61
pubmed: 21285093
JAMA Psychiatry. 2022 Apr 01;79(4):300-312
pubmed: 35171215
Drugs Real World Outcomes. 2018 Mar;5(1):35-43
pubmed: 29185233
Prim Care Companion J Clin Psychiatry. 2002 Feb;4(1):9-11
pubmed: 15014728
Lancet. 2018 Apr 7;391(10128):1357-1366
pubmed: 29477251
Cleve Clin J Med. 2008 Jan;75(1):57-66
pubmed: 18236731
J Clin Psychiatry. 2009;70 Suppl 6:26-31
pubmed: 19922741
J Gen Intern Med. 2001 Sep;16(9):606-13
pubmed: 11556941
Int J Neuropsychopharmacol. 2020 Dec 3;23(9):587-625
pubmed: 32402075
Transl Psychiatry. 2021 Oct 16;11(1):531
pubmed: 34657142
Can J Psychiatry. 2009 Jun;54(6):389-98
pubmed: 19527559
Psychol Med. 2012 Jun;42(6):1131-49
pubmed: 22008447
Eur Arch Psychiatry Clin Neurosci. 2017 Dec;267(8):711-721
pubmed: 28421334
Psychiatry Res. 2017 Jun;252:277-283
pubmed: 28288438
J Affect Disord. 2022 Apr 1;302:385-400
pubmed: 34986373
Psychol Med. 2020 Oct 20;:1-11
pubmed: 33077023
Depress Anxiety. 2020 Feb;37(2):134-145
pubmed: 31638723
Am J Psychiatry. 2011 Dec;168(12):1266-77
pubmed: 22193671
Can J Psychiatry. 2016 Sep;61(9):540-60
pubmed: 27486148
Psychiatry Res. 2016 Jun 30;240:421-430
pubmed: 27155594
PLoS One. 2020 Jul 30;15(7):e0236434
pubmed: 32730324
Arch Gen Psychiatry. 2001 Apr;58(4):395-401
pubmed: 11296101
Psychol Med. 2007 Jun;37(6):893-904
pubmed: 17335635
J Clin Psychiatry. 2009 Mar;70(3):344-53
pubmed: 19254516
Int Clin Psychopharmacol. 2008 Mar;23(2):70-83
pubmed: 18301121
Psychol Med. 2009 Mar;39(3):403-12
pubmed: 18606049
J Clin Psychiatry. 2001 Sep;62(9):701-6
pubmed: 11681766
Br J Addict. 1991 Sep;86(9):1119-27
pubmed: 1932883
Br J Psychiatry. 2017 Feb;210(2):119-124
pubmed: 27908899
BMC Psychiatry. 2019 Aug 28;19(1):262
pubmed: 31455302
J Affect Disord. 2006 Nov;96(1-2):9-20
pubmed: 16793140
Arch Gen Psychiatry. 2005 Jun;62(6):629-40
pubmed: 15939840
Acta Psychiatr Scand. 2021 May;143(5):434-443
pubmed: 33404081
J Clin Psychiatry. 2018 May 29;79(4):
pubmed: 29873959
Int J Neuropsychopharmacol. 2015 May 25;18(11):pyv060
pubmed: 26012350
J Pers Disord. 2003 Dec;17(6):568-73
pubmed: 14744082
J Clin Psychiatry. 2008 Sep;69(9):1423-36
pubmed: 19193343
J Clin Psychiatry. 2021 Sep 28;82(5):
pubmed: 34587377
J Psychopharmacol. 2021 Aug;35(8):890-900
pubmed: 34238049
BMC Psychiatry. 2015 Mar 11;15:47
pubmed: 25881327
Ann Fam Med. 2007 Mar-Apr;5(2):126-34
pubmed: 17389536
J Clin Psychiatry. 2004 Jun;65(6):810-9
pubmed: 15291658
J Clin Psychiatry. 2005 Feb;66(2):220-7
pubmed: 15705008
Br J Psychiatry. 2007 Feb;190:172-3
pubmed: 17267936
J Affect Disord. 2022 Jul 1;308:236-242
pubmed: 35398108
J Psychiatr Res. 2021 Mar;135:197-202
pubmed: 33493949
Soc Psychiatry Psychiatr Epidemiol. 2009 May;44(5):385-92
pubmed: 18946624
Am J Psychiatry. 2015 Oct;172(10):1004-13
pubmed: 26315978
J Clin Psychopharmacol. 2012 Feb;32(1):114-9
pubmed: 22198447
J Affect Disord. 2015 Feb 1;172:462-71
pubmed: 25451451
Depress Anxiety. 2006;23(4):245-9
pubmed: 16688739
Ger Med Sci. 2004 Feb 26;2:Doc01
pubmed: 19675684
J Clin Psychiatry. 2015 Apr;76(4):e487-98
pubmed: 25919841
Am J Psychiatry. 2006 Nov;163(11):1905-17
pubmed: 17074942
J Affect Disord. 2019 Jan 15;243:503-515
pubmed: 30286415
J Clin Psychiatry. 2021 Nov 2;82(6):
pubmed: 34727421
J Clin Pharmacol. 2022 Jun;62(6):721-732
pubmed: 34967946
Br J Psychiatry. 1995 Jul;167(1):99-103
pubmed: 7551619
Br J Psychiatry. 2019 Jan;214(1):42-51
pubmed: 30457075
J Psychopharmacol. 2023 Mar;37(3):268-278
pubmed: 35861202
J Affect Disord. 2011 May;130(3):395-404
pubmed: 21112639
JAMA. 2003 Jun 18;289(23):3095-105
pubmed: 12813115
Gen Hosp Psychiatry. 2005 Mar-Apr;27(2):87-96
pubmed: 15763119
J Affect Disord. 2009 Jul;116(1-2):4-11
pubmed: 19007996
Aust N Z J Psychiatry. 2021 Jan;55(1):7-117
pubmed: 33353391
Am J Psychiatry. 2010 Dec;167(12):1445-55
pubmed: 20843873