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Current Neuropharmacology

Author(s): Bernardo Dell'Osso, Marco Di Nicola, Riccardo Cipelli, Ilaria Peduto, Anna Cristina Pugliese, Maria Salvina Signorelli, Antonio Ventriglio and Giovanni Martinotti*

DOI: 10.2174/1570159X20666220222142310

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Antidepressant Prescription for Major Depressive Disorder: Results from a Population-Based Study in Italy

Page: [2381 - 2392] Pages: 12

  • * (Excluding Mailing and Handling)

Abstract

Objectives: There is limited evidence about the factors influencing antidepressant (AD) prescription for the treatment of major depressive disorder (MDD) in Real World clinical practice in Italy. In this retrospective, population-based study, we set out to describe a patient cohort initiated on AD treatment for MDD and investigate the possible predictors of different AD prescriptions in the primary care setting.

Methods: Patients with a diagnosis of MDD who received an initial prescription of one of 11 selected ADs between 1-Apr-2017 and 31-Mar-2019 (index date) were identified from primary care electronic medical records in the Longitudinal Patient Database. Patients prescribed ≥1 AD in the 12 months before the index date were excluded. Results were stratified by AD molecule. Multivariable logistic regression models estimated the association between patients’ demographic, clinical factors, and choice of AD molecule.

Results: The study cohort comprised 8,823 patients (67.1% female; mean age 61.6 years). Previous AD treatments (prescribed in the 10 years before the index date) had been received by 46.6% of patients (non-naïve patients). The most commonly reported psychiatric and medical comorbidities reported in the 12 months before the index date were anxiety (8.4%) and hypertension (41.9%), respectively. Patients’ age was a significant predictor of AD molecule prescribed at index date in eight of the 11 molecules investigated, while patients’ gender influenced clinician prescribing bupropion, citalopram, fluoxetine, fluvoxamine, sertraline, and vortioxetine.

Conclusion: Results from this Real World study provide useful information for clinicians on the clinical factors influencing AD prescription in patients treated for MDD in primary care.

Keywords: antidepressant, major depressive disorder, primary care, population-based, longitudinal, Real World study, prescribing pattern

Graphical Abstract

[1]
Ter Meulen, W.G.; Draisma, S.; van Hemert, A.M.; Schoevers, R.A.; Kupka, R.W.; Beekman, A.T.F.; Penninx, B.W.J.H. Depressive and anxiety disorders in concert-A synthesis of findings on comorbidity in the NESDA study. J. Affect. Disord., 2021, 284, 85-97.
[http://dx.doi.org/10.1016/j.jad.2021.02.004] [PMID: 33588240]
[2]
Barkin, R.L.; Schwer, W.A.; Barkin, S.J. Recognition and management of depression in primary care: A focus on the elderly. A pharmacotherapeutic overview of the selection process among the traditional and new antidepressants. Am. J. Ther., 2000, 7(3), 205-226.
[http://dx.doi.org/10.1097/00045391-200007030-00008] [PMID: 11317169]
[3]
Craven, M.A.; Bland, R. Depression in primary care: Current and future challenges. Can. J. Psychiatry, 2013, 58(8), 442-448.
[http://dx.doi.org/10.1177/070674371305800802] [PMID: 23972105]
[4]
Pence, B.W.; O’Donnell, J.K.; Gaynes, B.N. The depression treatment cascade in primary care: A public health perspective. Curr. Psychiatry Rep., 2012, 14(4), 328-335.
[http://dx.doi.org/10.1007/s11920-012-0274-y] [PMID: 22580833]
[5]
Gaynes, B.N.; Rush, A.J.; Trivedi, M.; Wisniewski, S.R.; Balasubramani, G.K.; Spencer, D.C.; Petersen, T.; Klinkman, M.; Warden, D.; Schneider, R.K.; Castro, D.B.; Golden, R.N. A direct comparison of presenting characteristics of depressed outpatients from primary vs. specialty care settings: Preliminary findings from the STAR*D clinical trial. Gen. Hosp. Psychiatry, 2005, 27(2), 87-96.
[http://dx.doi.org/10.1016/j.genhosppsych.2004.10.003] [PMID: 15763119]
[6]
Gaynes, B.N.; Rush, A.J.; Trivedi, M.H.; Wisniewski, S.R.; Balasubramani, G.K.; Spencer, D.C.; Petersen, T.; Klinkman, M.; Warden, D.; Nicholas, L.; Fava, M. Major depression symptoms in primary care and psychiatric care settings: A cross-sectional analysis. Ann. Fam. Med., 2007, 5(2), 126-134.
[http://dx.doi.org/10.1370/afm.641] [PMID: 17389536]
[7]
Gonda, X.; Sharma, S.R.; Tarazi, F.I. Vortioxetine: A novel antidepressant for the treatment of major depressive disorder. Expert Opin. Drug Discov., 2019, 14(1), 81-89.
[http://dx.doi.org/10.1080/17460441.2019.1546691] [PMID: 30457395]
[8]
Cleare, A.; Pariante, C.M.; Young, A.H.; Anderson, I.M.; Christmas, D.; Cowen, P.J.; Dickens, C.; Ferrier, I.N.; Geddes, J.; Gilbody, S.; Haddad, P.M.; Katona, C.; Lewis, G.; Malizia, A.; McAllister-Williams, R.H.; Ramchandani, P.; Scott, J.; Taylor, D.; Uher, R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J. Psychopharmacol. (Oxf.), 2015, 29(5), 459-525.
[http://dx.doi.org/10.1177/0269881115581093] [PMID: 25969470]
[9]
Aguglia, E.; Ravasio, R.; Simonetti, M.; Pecchioli, S.; Mazzoleni, F. Use and treatment modalities for SSRI and SNRI antidepressants in Italy during the period 2003-2009. Curr. Med. Res. Opin., 2012, 28(9), 1475-1484.
[http://dx.doi.org/10.1185/03007995.2012.713341] [PMID: 22809113]
[10]
Sultana, J.; Italiano, D.; Spina, E.; Cricelli, C.; Lapi, F.; Pecchioli, S.; Gambassi, G.; Trifirò, G. Changes in the prescribing pattern of antidepressant drugs in elderly patients: An Italian, nationwide, population-based study. Eur. J. Clin. Pharmacol., 2014, 70(4), 469-478.
[http://dx.doi.org/10.1007/s00228-013-1636-z] [PMID: 24425146]
[11]
Poluzzi, E.; Piccinni, C.; Sangiorgi, E.; Clo, M.; Tarricone, I.; Menchetti, M.; De Ponti, F. Trend in SSRI-SNRI antidepressants prescription over a 6-year period and predictors of poor adherence. Eur. J. Clin. Pharmacol., 2013, 69(12), 2095-2101.
[http://dx.doi.org/10.1007/s00228-013-1567-8] [PMID: 23904053]
[12]
Cai, T.; Palagin, I.; Brunelli, R.; Cipelli, R.; Pellini, E.; Truzzi, J.C.; Van Bruwaene, S. Office-based approach to urinary tract infections in 50 000 patients: Results from the REWIND study. Int. J. Antimicrob. Agents, 2020, 56(1), 105966.
[http://dx.doi.org/10.1016/j.ijantimicag.2020.105966] [PMID: 32325202]
[13]
Italian Medicines Agency. The Medicines Utilisation Monitoring Centre. National Report on Medicines Use in Italy. Year 2019; Italian Medicines Agency: Rome, 2020.
[14]
Cascade, E.F.; Kalali, A.H.; Thase, M.E. Use of antidepressants: Expansion beyond depression and anxiety. Psychiatry (Edgmont), 2007, 4(12), 25-28.
[PMID: 20436760]
[15]
Kessler, R.C. Epidemiology of women and depression. J. Affect. Disord., 2003, 74(1), 5-13.
[http://dx.doi.org/10.1016/S0165-0327(02)00426-3] [PMID: 12646294]
[16]
Gomez-Lumbreras, A.; Ferrer, P.; Ballarín, E.; Sabaté, M.; Vidal, X.; Andretta, M.; Coma, A.; Ibáñez, L. Study of antidepressant use in 5 European settings. Could economic, sociodemographic and cultural determinants be related to their use? J. Affect. Disord., 2019, 249, 278-285.
[http://dx.doi.org/10.1016/j.jad.2019.01.039] [PMID: 30784725]
[17]
Taylor, W.D. Should antidepressant medication be used in the elderly? Expert Rev. Neurother., 2015, 15(9), 961-963.
[http://dx.doi.org/10.1586/14737175.2015.1070671] [PMID: 26196054]
[18]
O’Neill, A.; McFarland, J.; Kelly, D. Long-term antidepressant use in a cohort of older people. Int. J. Geriatr. Psychiatry, 2021, 36(8), 1241-1251.
[http://dx.doi.org/10.1002/gps.5518] [PMID: 33592673]
[19]
Aina, Y.; Susman, J.L. Understanding comorbidity with depression and anxiety disorders. J. Am. Osteopath. Assoc., 2006, 106(5)(Suppl. 2), S9-S14.
[PMID: 16738013]
[20]
Kang, H-J.; Kim, S-Y.; Bae, K-Y.; Kim, S-W.; Shin, I-S.; Yoon, J-S.; Kim, J-M. Comorbidity of depression with physical disorders: Research and clinical implications. Chonnam Med. J., 2015, 51(1), 8-18.
[http://dx.doi.org/10.4068/cmj.2015.51.1.8] [PMID: 25914875]
[21]
Williams, D.; Kelly, A.; Feely, J. Association between SSRIs and upper gastrointestinal bleeding. Coprescription of antiulcer drugs with SSRIs is fairly common. BMJ, 2000, 320(7246), 1405.
[http://dx.doi.org/10.1136/bmj.320.7246.1405] [PMID: 10858058]
[22]
Clapp, M.; Aurora, N.; Herrera, L.; Bhatia, M.; Wilen, E.; Wakefield, S. Gut microbiota’s effect on mental health: The gut-brain axis. Clin. Pract., 2017, 7(4), 987.
[http://dx.doi.org/10.4081/cp.2017.987] [PMID: 29071061]
[23]
Sgambato, D.; Capuano, A.; Sullo, M.G.; Miranda, A.; Federico, A.; Romano, M. Gut-brain axis in gastric mucosal damage and protection. Curr. Neuropharmacol., 2016, 14(8), 959-966.
[http://dx.doi.org/10.2174/1570159X14666160223120742] [PMID: 26903151]
[24]
Person, H.; Keefer, L. Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Prog. Neuropsychopharmacol. Biol. Psychiatry, 2021, 107, 110209.
[http://dx.doi.org/10.1016/j.pnpbp.2020.110209] [PMID: 33326819]
[25]
Estrela, M.; Herdeiro, M.T.; Ferreira, P.L.; Roque, F. The use of antidepressants, anxiolytics, sedatives and hypnotics in Europe: Focusing on mental health care in Portugal and prescribing in older patients. Int. J. Environ. Res. Public Health, 2020, 17(22), 8612.
[http://dx.doi.org/10.3390/ijerph17228612] [PMID: 33228203]
[26]
Khong, T.P.; de Vries, F.; Goldenberg, J.S.B.; Klungel, O.H.; Robinson, N.J.; Ibáñez, L.; Petri, H. Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States. Calcif. Tissue Int., 2012, 91(1), 24-31.
[http://dx.doi.org/10.1007/s00223-012-9603-8] [PMID: 22566242]
[27]
Köhler, O.; Benros, M.E.; Nordentoft, M.; Farkouh, M.E.; Iyengar, R.L.; Mors, O.; Krogh, J. Effect of anti-inflammatory treatment on depression, depressive symptoms, and adverse effects: A systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry, 2014, 71(12), 1381-1391.
[http://dx.doi.org/10.1001/jamapsychiatry.2014.1611] [PMID: 25322082]
[28]
Dregan, A.; Matcham, F.; Harber-Aschan, L.; Rayner, L.; Brailean, A.; Davis, K.; Hatch, S.; Pariante, C.; Armstrong, D.; Stewart, R.; Hotopf, M. Common mental disorders within chronic inflammatory disorders: A primary care database prospective investigation. Ann. Rheum. Dis., 2019, 78(5), 688-695.
[http://dx.doi.org/10.1136/annrheumdis-2018-214676] [PMID: 30846444]
[29]
Brown, E.S.; Khan, D.A.; Nejtek, V.A. The psychiatric side effects of corticosteroids. Ann. Allergy Asthma Immunol., 1999, 83(6 Pt 1), 495-503.
[http://dx.doi.org/10.1016/S1081-1206(10)62858-X] [PMID: 10619339]
[30]
Benfield, P.; Heel, R.C.; Lewis, S.P. Fluoxetine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs, 1986, 32(6), 481-508.
[http://dx.doi.org/10.2165/00003495-198632060-00002] [PMID: 2878798]
[31]
Martényi, F.; Dossenbach, M.; Mraz, K.; Metcalfe, S. Gender differences in the efficacy of fluoxetine and maprotiline in depressed patients: A double-blind trial of antidepressants with serotonergic or norepinephrinergic reuptake inhibition profile. Eur. Neuropsychopharmacol., 2001, 11(3), 227-232.
[http://dx.doi.org/10.1016/S0924-977X(01)00089-X] [PMID: 11418283]
[32]
Young, E.A.; Kornstein, S.G.; Marcus, S.M.; Harvey, A.T.; Warden, D.; Wisniewski, S.R.; Balasubramani, G.K.; Fava, M.; Trivedi, M.H.; John Rush, A. Sex differences in response to citalopram: A STAR*D report. J. Psychiatr. Res., 2009, 43(5), 503-511.
[http://dx.doi.org/10.1016/j.jpsychires.2008.07.002] [PMID: 18752809]
[33]
Jacobsen, P.L.; Harper, L.; Chrones, L.; Chan, S.; Mahableshwarkar, A.R. Safety and tolerability of vortioxetine (15 and 20 mg) in patients with major depressive disorder: Results of an open-label, flexible-dose, 52-week extension study. Int. Clin. Psychopharmacol., 2015, 30(5), 255-264.
[http://dx.doi.org/10.1097/YIC.0000000000000081] [PMID: 26020712]
[34]
Serretti, A.; Chiesa, A. Treatment-emergent sexual dysfunction related to antidepressants: A meta-analysis. J. Clin. Psychopharmacol., 2009, 29(3), 259-266.
[http://dx.doi.org/10.1097/JCP.0b013e3181a5233f] [PMID: 19440080]
[35]
Clayton, A.; Keller, A.; McGarvey, E.L. Burden of phase-specific sexual dysfunction with SSRIs. J. Affect. Disord., 2006, 91(1), 27-32.
[http://dx.doi.org/10.1016/j.jad.2005.12.007] [PMID: 16430968]
[36]
Deakin, J.B.; Rahman, S.; Nestor, P.J.; Hodges, J.R.; Sahakian, B.J. Paroxetine does not improve symptoms and impairs cognition in frontotemporal dementia: A double-blind randomized controlled trial. Psychopharmacology (Berl.), 2004, 172(4), 400-408.
[http://dx.doi.org/10.1007/s00213-003-1686-5] [PMID: 14666399]
[37]
Anttila, S.A.; Leinonen, E.V. A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev., 2001, 7(3), 249-264.
[http://dx.doi.org/10.1111/j.1527-3458.2001.tb00198.x] [PMID: 11607047]
[38]
Fox, C.B.; Treadway, A.K.; Blaszczyk, A.T.; Sleeper, R.B. Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly. Pharmacotherapy, 2009, 29(4), 383-397.
[http://dx.doi.org/10.1592/phco.29.4.383] [PMID: 19323618]
[39]
Baune, B.T.; Sluth, L.B.; Olsen, C.K. The effects of vortioxetine on cognitive performance in working patients with major depressive disorder: A short-term, randomized, double-blind, exploratory study. J. Affect. Disord., 2018, 229, 421-428.
[http://dx.doi.org/10.1016/j.jad.2017.12.056] [PMID: 29331703]
[40]
Holm, K.J.; Spencer, C.M. Bupropion: A review of its use in the management of smoking cessation. Drugs, 2000, 59(4), 1007-1024.
[http://dx.doi.org/10.2165/00003495-200059040-00019] [PMID: 10804045]
[41]
Plodkowski, R.A.; Nguyen, Q.; Sundaram, U.; Nguyen, L.; Chau, D.L.; St Jeor, S. Bupropion and naltrexone: A review of their use individually and in combination for the treatment of obesity. Expert Opin. Pharmacother., 2009, 10(6), 1069-1081.
[http://dx.doi.org/10.1517/14656560902775750] [PMID: 19364254]
[42]
Rush, A.J.; Batey, S.R.; Donahue, R.M.; Ascher, J.A.; Carmody, T.J.; Metz, A. Does pretreatment anxiety predict response to either bupropion SR or sertraline? J. Affect. Disord., 2001, 64(1), 81-87.
[http://dx.doi.org/10.1016/S0165-0327(00)00250-0] [PMID: 11292522]
[43]
Trivedi, M.H.; Rush, A.J.; Carmody, T.J.; Donahue, R.M.; Bolden-Watson, C.; Houser, T.L.; Metz, A. Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients? J. Clin. Psychiatry, 2001, 62(10), 776-781.
[http://dx.doi.org/10.4088/JCP.v62n1005] [PMID: 11816866]
[44]
Baldwin, D.S.; Florea, I.; Jacobsen, P.L.; Zhong, W.; Nomikos, G.G. A meta-analysis of the efficacy of vortioxetine in patients with major depressive disorder (MDD) and high levels of anxiety symptoms. J. Affect. Disord., 2016, 206, 140-150.
[http://dx.doi.org/10.1016/j.jad.2016.07.015] [PMID: 27474960]
[45]
Keyloun, K.R.; Hansen, R.N.; Hepp, Z.; Gillard, P.; Thase, M.E.; Devine, E.B. Adherence and persistence across antidepressant therapeutic classes: A retrospective claims analysis among insured US patients with Major Depressive Disorder (MDD). CNS Drugs, 2017, 31(5), 421-432.
[http://dx.doi.org/10.1007/s40263-017-0417-0] [PMID: 28378157]