Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

Multicenter, non-interventional study in adult outpatients with a DSM-IV-TR diagnosis of MDD and inadequate response to first-line antidepressant medication. Multiple logistic regression analyses were performed to identify independent factors associated with the adoption of a specific second-line strategy.A total of 273 patients were analyzed (mean age: 46.8 years, 67.8% female). Baseline mean Montgomery-Asberg Depression Rating Scale total score was 32.1 (95%CI 31.2-32.9). The most common strategies were: switching antidepressant medication (39.6%), augmentation (18.8%), and combination therapy (17.9%). Atypical antipsychotic drugs were the most commonly used agent for augmenting antidepressant effect. The presence of psychotic symptoms and the number of previous major depressive episodes were associated with the adoption of augmenting strategy (OR？=？3.2 and 1.2, respectively).The switch to another antidepressant agent was the most common second-line therapeutic approach. Psychiatrists chose augmentation based on a worse patients’ clinical profile (number of previous episodes and presence of psychotic symptoms).Major depression is one of the most prevalent mental disorders in Europe, with an estimated prevalence of 6.9% [1]. According to some projections, major depressive disorder (MDD) will be one of the three leading causes of burden of disease in 2030 [2].Despite the introduction of newer-generation antidepressants, approximately 50% of patients experience non-response to treatment with a first-line antidepressant [3,4]. The presence of residual symptoms has been associated with a higher risk of recurrence, more chronic depressive episodes, a shorter duration between episodes, and a worse functioning [5-7]. In addition, not achieving symptomatic remission increases the economic burden of this mental disorder which is mainly explained by loss of productivity due to disability and absenteeism and to the use of healthcare resources such as medical visits and pharma