The following is a summary of “Prospective study of antidepressant treatment of psychiatric patients with depressive disorders: treatment adequacy and outcomes,” published in the November 2023 issue of Psychiatry by Knorring et al.
Suboptimal antidepressant treatment continues to pose a challenge despite the existence of national depression care guidelines (DCGs).
Researchers conducted a retrospective study to investigate the relationship between DCG concordance and treatment outcomes for depression in psychiatric settings.
They assessed the treatment received and outcomes of 128 psychiatric out- and inpatients involved in the PEGAD (Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders) study at baseline, 2 weeks, and 8 weeks using interviews and questionnaires. Inclusion criteria comprised an ICD-10 diagnosis of a depressive disorder, a Patient Health Questionnaire-9 symptom (PHQ-9) score ≥ 10, and a newly prescribed antidepressant. The primary focus of the study was the within-individual change in PHQ-9 scores.
The results showed that at baseline, 83% of patients had predominantly recurrent depression, and 19% had treatment-resistant depression (TRD). The median duration of the current episode was 6.5 months. After eight weeks, 85% of patients (n = 107) used a DCG-concordant antidepressant dose. Due to limited options, TRD patients had lower adequate treatment rates than non-TRD patients (25% vs. 84%, P<0.005). One-third of patients experienced inadequate follow-up. In total, only 53% received treatment in line with DCG recommendations for both pharmacotherapy and follow-up. The mean decrease in PHQ-9 scores (-3.8 ± SD 5.7) was statistically significant (P<0.0005), and 40% of patients reached a subthreshold level of depression (PHQ-9 < 10), predicted by a lower baseline PHQ-9 score, recurrent depression, and female sex. Nearly half did not show significant clinical improvement. (PHQ-9 score reduction < 20%).
They concluded that inadequate treatment persists in psychiatric settings, especially for TRD patients.
Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05390-8