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Lopez-Saavedra J, Abad-Santos F. Cost-effectiveness of pharmacogenetic screening in the management of major depressive disorder in the Spanish Healthcare System. J Affect Disord 2024; 365:597-605. [PMID: 39187185 DOI: 10.1016/j.jad.2024.08.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/15/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) represents a sizable economic burden in Spain. Pharmacogenetic (PGx) screening to guide the choice of antidepressant medication (ADM) in MDD patients yields higher response and remission rates, which could reduce both healthcare and indirect costs. METHODS We built a cost-effectiveness probabilistic Markov model with microsimulation using Tree Age Pro 2022, simulating a patient cohort from the SNHS starting ADM for MDD, and comparing PGx screening before starting ADM versus no screening (No PGx). We carried out a probabilistic sensitivity analysis using the Monte Carlo simulation with microsimulation, set for 1000 iterations and 1000 microsimulation trials, both from societal and healthcare provider perspectives, for a time horizon of 3 years. RESULTS From a societal perspective, the model estimated a mean cost of 3172.85€ and effectiveness of 2.64 quality-adjusted life years (QALYs) for the No PGx strategy, and a mean cost of 1687.02€ and effectiveness of 2.84 QALYs for the PGx strategy. The mean ICER was -7820.56 €/QALY. From a healthcare provider perspective (no indirect costs considered), the mean cost was 662.62€ for the No PGx strategy, and 446.60€ for the PGx strategy. The mean ICER was -1130.16 €/QALY. LIMITATIONS The heterogeneity of input data from the literature, the need for assumptions of homogeneous distribution of variables and events across population and time, and the inherent limitations of cost-effectiveness analysis should be considered. The model omits combined therapies (ADMs with mood stabilizers, antipsychotics, cognitive behavioral therapy…). CONCLUSIONS PGx screening in MDD prior to ADM start is a dominant strategy in the SNHS.
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Affiliation(s)
- Javier Lopez-Saavedra
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-Princesa), Faculty of Medicine, Universidad Autónoma de Madrid (UAM), 28029 Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-Princesa), Faculty of Medicine, Universidad Autónoma de Madrid (UAM), 28029 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
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Eckert KA, Fife CE, Carter MJ. The Impact of Underlying Conditions on Quality-of-Life Measurement Among Patients with Chronic Wounds, as Measured by Utility Values: A Review with an Additional Study. Adv Wound Care (New Rochelle) 2023; 12:680-695. [PMID: 37815559 PMCID: PMC10615090 DOI: 10.1089/wound.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 10/11/2023] Open
Abstract
Significance: Quality of life (QoL) is important to patients with chronic wounds and is rarely formally evaluated. Understanding what comorbidities most affect the individual versus their wounds could be a key metric. Recent Advances: The last 20 years have seen substantial advances in QoL instruments and conversion of patient data to a single value known as the health utilities index (HUI). We review these advances, along with wound-related QoL, and analyze real-world comorbidities challenging wound care. Critical Issues: To understand the impact of underlying comorbidities in a real-world patient population, we examined a convenience sample of 382 patients seen at a hospital-based outpatient wound center. This quality reporting study falls outside the regulations that govern human subject research. Comorbid conditions were used to calculate HUIs using a variety of literature-reported approaches, while Wound-Quality-of-Life (W-QoL) questionnaire data were collected from patients during their first visit. The mean number of conditions per patient was 8; 229 patients (59.9%) had utility values for comorbidities/conditions, which were worse/lower than their wounds' values. Sixty-three (16.5%) patients had depression and/or anxiety, 64 (16.8%) had morbid obesity, and 204 (53.4%) had gait and mobility disorders, all of which could have affected W-QoL scoring. The mean minimum utility value (0.5) was within 0.05 units of an average of 13 studies reporting health utilities from wound care populations using the EuroQol 5 Dimension instrument. Future Directions: The comorbidity associated with the lowest utility value is what might most influence the QoL of patients with chronic wounds. This finding needs further investigation.
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Affiliation(s)
| | - Caroline E. Fife
- Intellicure, LLC, The Woodlands, Texas, USA
- U.S. Wound Registry (501 3C Nonprofit), The Woodlands, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
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Li CT. Overview of treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 278:1-23. [PMID: 37414489 DOI: 10.1016/bs.pbr.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Patients with major depressive disorder (MDD) often exhibit an inadequate treatment response or failure to achieve remission following treatment with antidepressant drugs. Treatment-resistant depression (TRD) is proposed to identify this clinical scenario. Compared to those without TRD, patients with TRD have significantly lower health-related quality of life in mental and physical dimensions, more functional impairment and productivity loss, and higher healthcare costs. TRD imposes a massive burden on the individual, family, and society. However, a lack of consensus on the TRD definition limits the comparison and interpretation of TRD treatment efficacy across trials. Furthermore, because of the various TRD definitions, there is scarce treatment guideline specifically for TRD, in contrast to the rich treatment guidelines for MDD. In this chapter, common issues related to TRD, such as proper definitions of an adequate antidepressant trial and TRD, were carefully reviewed. Prevalence of and clinical outcomes related to TRD were summarized. We also summarized the staging models ever proposed for the diagnosis of TRD. Furthermore, we highlighted variations in the definition regarding the lack of or an inadequate response in treatment guidelines for depression. Up-to-date treatment options for TRD, including pharmacological strategies, psychotherapeutic interventions, neurostimulation techniques, glutamatergic compounds, and even experimental agents were reviewed.
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Affiliation(s)
- Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine and Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Goodwin GM, Aaronson ST, Alvarez O, Atli M, Bennett JC, Croal M, DeBattista C, Dunlop BW, Feifel D, Hellerstein DJ, Husain MI, Kelly JR, Lennard-Jones MR, Licht RW, Marwood L, Mistry S, Páleníček T, Redjep O, Repantis D, Schoevers RA, Septimus B, Simmons HJ, Soares JC, Somers M, Stansfield SC, Stuart JR, Tadley HH, Thiara NK, Tsai J, Wahba M, Williams S, Winzer RI, Young AH, Young MB, Zisook S, Malievskaia E. Single-dose psilocybin for a treatment-resistant episode of major depression: Impact on patient-reported depression severity, anxiety, function, and quality of life. J Affect Disord 2023; 327:120-127. [PMID: 36740140 DOI: 10.1016/j.jad.2023.01.108] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND COMP360 is a proprietary, synthetic formulation of psilocybin being developed for treatment-resistant depression (TRD), a burdensome, life-threatening illness with high global impact. Here, we expand upon the previous report of primary outcomes from a phase 2 study of COMP360 in individuals with TRD-the largest randomised controlled clinical trial of psilocybin-to discuss findings of the exploratory efficacy endpoints. METHODS In this phase 2, double-blind trial, 233 participants with TRD were randomised to receive a single dose of psilocybin 25 mg, 10 mg, or 1 mg (control), administered alongside psychological support from trained therapists. Efficacy measures assessed patient-reported depression severity, anxiety, positive and negative affect, functioning and associated disability, quality of life, and cognitive function. RESULTS At Week 3, psilocybin 25 mg, compared with 1 mg, was associated with greater improvements from Baseline total scores in all measures. The 10 mg dose produced smaller effects across these measures. LIMITATIONS Interpretation of this trial is limited by the absence of an active comparator and the possibility of functional unblinding in participants who received a low dose of psilocybin. CONCLUSIONS Three weeks after dosing, psilocybin 25 mg and, to a lesser degree, 10 mg improved measures of patient-reported depression severity, anxiety, affect, and functioning. These results extend the primary findings from the largest randomised clinical trial of psilocybin for TRD to examine other outcomes that are of importance to patients.
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Affiliation(s)
| | - Scott T Aaronson
- The Institute for Advanced Diagnostics and Therapeutics, Sheppard Pratt, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Oscar Alvarez
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Sant Joan de Déu Research Foundation, Barcelona, Spain
| | | | | | | | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David Feifel
- Kadima Neuropsychiatric Institute, La Jolla, CA, USA
| | - David J Hellerstein
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - John R Kelly
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | | | - Rasmus W Licht
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Tomáš Páleníček
- The National Institute of Mental Health, Klecany, Czech Republic
| | | | - Dimitris Repantis
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Centre Groningen, Groningen, the Netherlands
| | | | | | - Jair C Soares
- UTHealth Harris County Psychiatric Center, Houston, TX, USA; Department of Psychiatry and Behavioral Sciences, UTHealth Center of Excellence on Mood Disorders, UT Houston Medical School, Houston, TX, USA
| | - Metten Somers
- Department of Psychiatry, University Medical Centre Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | - Mourad Wahba
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK; Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | | | - Sid Zisook
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Cheng CM, Jeng JS. Psychiatric rehabilitation and cognitive deficit for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:91-113. [PMID: 37806718 DOI: 10.1016/bs.pbr.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Patients with TRD often experience persistent impairment of affective, psychosocial, and cognitive function, which impedes their recovery. The continuation of pharmacotherapy for patients with TRD remains the cornerstone of functional recovery. Cognitive dysfunction is prevalent in patients with MDD and may make patients' depressive symptoms and psychosocial functioning worse, even in the remitted stage of illness. Deficits can manifest not only in specific cognitive domains but also in global cognitive function, which may reflect underlying persistent pathophysiological changes. Compared with nontreatment-resistant patients with MDD, patients with TRD exhibit greater subjective and objective cognitive impairment, which possibly contributes to a greater adverse impact on daily functioning. Cognitive and psychosocial remission should be a goal in treating MDD. How to appropriately and individualized perform pharmacological intervention, psychotherapy, neuromodulation, cognitive remediation or other rehabilitation treatment programs is a critical step to achieve our goal. Integrating multiple interventions that engage multiple physiological systems with a multidisciplinary team warrants increased attention, and personalized therapeutic programs may facilitate the complete restoration of patients' everyday functioning.
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Affiliation(s)
- Chih-Ming Cheng
- Attending Psychiatrist, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Lecturer, Division of Psychiatry, College of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Jia-Shyun Jeng
- Attending Psychiatrist, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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Orsini LS, O'Connor SJ, Mohwinckel MT, Marwood L, Pahwa AS, Bryder MN, Dong X, Levine SP. Observational study to characterize treatment-resistant depression in Germany, France and the United Kingdom: analysis of real-world data collected through a survey of healthcare professionals. Curr Med Res Opin 2022; 38:2219-2226. [PMID: 36106382 DOI: 10.1080/03007995.2022.2113692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study describes treatment patterns, productivity, healthcare resource utilization and previous episodes of depression for patients with treatment-resistant depression (TRD). METHODS In this cross-sectional study, a quantitative survey was administered to 225 healthcare providers (HCPs) distributed evenly across Germany, France and the UK from July to August 2021. Each HCP was asked to answer based on medical records of five patients with TRD, defined as patients failing to respond to two or more treatments of adequate dose and duration in the same episode of major depressive disorder (MDD), which provided a sample size of 1125 patients. RESULTS Of the 1125 patients with TRD, 73.2% had two or more previous episodes of MDD, 46.3% had a history of suicidal ideation and 24.8% had attempted suicide. Only 26.8% of patients were employed either full-time or part-time. During the most recent/current TRD episode, 45.5% of patients received five or more lines of treatment, and 46.0% remained on monotherapy. For multiple pharmacological treatments, too many distinct combinations were used to discern trends. Overall, 60.6% of patients had at least one mental health-related hospitalization in the last 12 months; 35.0% had two or more hospitalizations. Half of TRD patients saw a doctor five or more times per year for their depression. CONCLUSIONS This study addresses the knowledge gap about treatment patterns and healthcare utilization in real-world practice for TRD patients in three European countries. It provides data that potentially could inform treatment guideline development and optimize patient-perceived benefits from the treatment of TRD.
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Affiliation(s)
| | | | | | | | - Ankit S Pahwa
- ICON PLC, ICON Commercialization and Outcomes, Bangalore, India
| | - Matti N Bryder
- ICON PLC, ICON Commercialization and Outcomes, Solna, Sweden
| | - Xinzhe Dong
- ICON PLC, ICON Commercialization and Outcomes, Vancouver, Canada
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Samalin L, Rothärmel M, Mekaoui L, Gaudré-Wattinne E, Codet MA, Bouju S, Sauvaget A. Esketamine nasal spray in patients with treatment-resistant depression: the real-world experience in the French cohort early-access programme. Int J Psychiatry Clin Pract 2022; 26:352-362. [PMID: 35174754 DOI: 10.1080/13651501.2022.2030757] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To present the first real-world data of patients with treatment-resistant depression (TRD) treated with esketamine through a French cohort Temporary Authorisation for Use (ATUc) programme. METHODS In 2019, the French Health Authorities exceptionally granted the first ATUc in psychiatry for TRD patients. Clinical characteristics, safety and efficacy data were reported by physicians. The ATUc ended ∼6 months after initiation. RESULTS The cohort (n = 66; median age 53.0 years; 62.1% female; 78.8% with severe major depressive episodes; resistance to a mean of 4.2 previous antidepressants) received esketamine treatment for a median of 30 days. Among 46 analysed patients, 22 (47.8%) achieved response (Montgomery-Åsberg Depression Rating Scale [MADRS] total score reduction ≥50.0%) and 17 (37.0%) achieved remission (MADRS total score of ≤12) at least once at a median of 18.5 (2.0-77.0) and 21.0 (2.0-46.0) days after initiation, respectively. By Week 4, patients had a 31.6% probability of achieving remission (Kaplan-Meier method). Sedation, somnolence, dizziness, hypertension, anxiety and dissociation were the most frequently reported (>10.0%) adverse events. No new safety signals were identified. CONCLUSIONS Patient characteristics of this cohort demonstrate high-level treatment resistance. The safety and efficacy of esketamine in patients with TRD in real-world clinical practice were consistent with Phase 3 trials.Key pointsPatients with treatment-resistant depression (TRD) exceptionally received esketamine nasal spray ahead of its launch through a French cohort Temporary Authorisation for Use (ATUc) programme.The clinical characteristics of 66 adult patients with TRD included in this cohort demonstrated a high-level of resistance to conventional treatments at the time of treatment request prior to esketamine initiation.No new safety signals were observed with esketamine initiation during the ATUc period compared with the Phase 3 clinical trials.The safety and efficacy of esketamine in the real world remain consistent with that established in Phase 3 clinical trials.The data collected during this ATUc also provide the first real-world data on the management and practical use of esketamine in a hospital setting in France.
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Affiliation(s)
- Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Maud Rothärmel
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry - Rouvray Hospital Centre, Sotteville-lès-Rouen, France
| | - Lila Mekaoui
- Mental and Brain Illness Clinic, Sainte-Anne Hospital, GHU Paris - Psychiatry and Neurosciences, Paris, France
| | | | | | - Sophie Bouju
- Medical Affairs, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement, Interactions, Performance (MIP), EA 4334, Nantes, France
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Heerlein K, De Giorgi S, Degraeve G, Frodl T, Hagedoorn W, Oliveira-Maia AJ, Otte C, Perez Sola V, Rathod S, Rosso G, Sierra P, Vita A, Morrens J, Rive B, Mulhern Haughey S, Kambarov Y, Young AH. Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization. J Affect Disord 2022; 298:442-450. [PMID: 34742998 DOI: 10.1016/j.jad.2021.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. METHODS This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. RESULTS Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. LIMITATIONS Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. CONCLUSION Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.
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Affiliation(s)
| | - S De Giorgi
- Department of Mental Health ASL Lecce, Lecce, Italy
| | - G Degraeve
- AZ Alma General Hospital, Eeklo, Belgium; PC Dr Guislain Hospital, Ghent, Belgium
| | - T Frodl
- Department of Psychiatry and Psychotherapy, Univeritätsklinikum Magdeburg, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - W Hagedoorn
- Practice for Psychiatry and Psychotherapy, Heerde, the Netherlands
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - C Otte
- Charité Universitätsmedizin, Berlin, Germany
| | - V Perez Sola
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona IMIM Hospital del Mar Medical Research Institute, Univ Autonoma de Barcelona, CIBERSAM, Barcelona, Spain
| | - S Rathod
- Research Department, Southern Health NHS Foundation Trust, Tom Rudd Unit, Southampton, United Kingdom
| | - G Rosso
- Department of Neurosciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - P Sierra
- University and Polytechnic Hospital La Fe, University of Valencia, Valencia, Spain
| | - A Vita
- Department of Mental Health and Addiction Services, Spedali Civili Hospital and University of Brescia, Brescia, Italy
| | | | - B Rive
- Janssen EMEA, Paris, France
| | | | | | - A H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
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Treatment-Resistant Depression in Poland—Epidemiology and Treatment. J Clin Med 2022; 11:jcm11030480. [PMID: 35159935 PMCID: PMC8837165 DOI: 10.3390/jcm11030480] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. Although several antidepressant drugs have been developed, up to 30% of patients fail to achieve remission, and acute remission rates decrease with the number of treatment steps required. The aim of the current project was to estimate and describe the population of treatment-resistant depression (TRD) patients in outpatient clinics in Poland. (2) Methods: The project involved a representative sample of psychiatrists working in outpatient clinics, chosen through a process of quota random sampling. The doctors completed two questionnaires on a consecutive series of patients with MDD, which captured the patients’ demographics, comorbidities, and medical histories. TRD was defined as no improvement seen after a minimum of two different antidepressant drug therapies applied in sufficient doses for a minimum of 4 weeks each. The data were weighted and extrapolated to the population of TRD outpatients in Poland. (3) Results: A total of 76 psychiatrists described 1781 MDD patients, out of which 396 fulfilled the criteria of TRD. The TRD patients constituted 25.2% of all MDD patients, which led to the number of TRD outpatients in Poland being estimated at 34,800. The demographics, comorbidities, medical histories, and histories of treatment of Polish TRD patients were described. In our sample of the TRD population (mean age: 45.6 ± 13.1 years; female: 64%), the patients had experienced 2.1 ± 1.6 depressive episodes (including the current one), and the mean duration of the current episode was 4.8 ± 4.4 months. In terms of treatment strategies, most patients (around 70%) received monotherapy during the first three therapies, while combination antidepressant drugs (ADs) were applied more often from the fourth line of treatment. The use of additional medications and augmentation was reported in only up to one third of the TRD patients. During all of the treatment steps, patients most often received a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI). (4) Conclusions: TRD is a serious problem, affecting approximately one fourth of all depressive patients and nearly 35,000 Poles.
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Perugi G, Calò P, De Filippis S, Rosso G, Vita A, Adami M, Ascione G, Morrens J, Delmonte D. Clinical Features and Outcomes of 124 Italian Patients With Treatment Resistant Depression: A Real-World, Prospective Study. Front Psychiatry 2021; 12:769693. [PMID: 34803777 PMCID: PMC8603563 DOI: 10.3389/fpsyt.2021.769693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: Treatment-resistant depression (TRD) is a debilitating condition affecting 20-30% of patients with major depressive disorders (MDD). Currently, there is no established standard of care for TRD, and wide variation in the clinical approach for disease management has been documented. Real-world data could help describe TRD clinical features, disease burden, and treatment outcome and identify a potential unmet medical need. Methods: We analyzed the Italian data from a European, prospective, multicentric, observational cohort study of patients fulfilling TRD criteria by the European Medicine Agency, with moderate to severe major depressive episode, and starting a new antidepressant treatment according to routinary clinical practice. They were followed up for minimum 6 months. Treatments received throughout the study period, disease severity, health-related quality of life and functioning were prospectively recorded and analyzed. Results: The Italian subcohort included 124 TRD patients (30.2% of patients of the European cohort; mean age 53.2 [sd = 9.8], women: 82, 66.1%). At enrollement, the mean (SD) duration of MDD was 16 years (sd = 11.1) and the mean duration of the ongoing major depressive episode (MDE) was 97.5 weeks (sd = 143.5); low scores of quality of life and functioning were reported. The most frequently antidepressant classes started at baseline (data available for 98 subjects) were selective serotonin reuptake inhibitors (SSRI, 42 patients [42.9%]) and serotonin-norepinephrine reuptake inhibitors (SNRI, 32 patients [32.7%]). In terms of treatment strategies, 50 patients (51%) started augmentation therapies, 18 (18.4%) combination therapies and 24 (24.5%) monoterapies (6 patients [6%] started a non-antidepressant drug only). Fourteen patients (11.3%) were treated with a psychosocial approach, including psychotherapy. After 6 months of treatment, clinical assessments were collected for 89 patients: 64 (71.9%) showed no response, 9 (10.1%) response without remission and 16 (18.0%) were in remission; non-responder patients showed lower quality of life and higher disability scores than responder patients. Conclusions: In our sample of TRD patients, we documented substantial illness burden, low perceived quality of life and poor outcome, suggesting an unmet treatment need in TRD care in Italy. Registration Number: ClinicalTrials.gov, number: NCT03373253.
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Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Calò
- Mental Health Department, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | | | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Torino, Turin, Italy.,San Luigi Gonzaga University Hospital of Orbassano, Orbassano, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
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