Pharmacological treatment strategies in unipolar depression in European tertiary psychiatric treatment centers - A pharmacoepidemiological cross-sectional multicenter study.
This multicenter, cross-sectional study with retrospective assessment of treatment response evaluated the current prescription trends and pharmacological treatment strategies applied in European university/academic psychiatric centers in unipolar depression. Altogether, 1181 adult in- and outpatients with major depressive disorder (MDD) were enrolled in 9 academic sites in 8 European countries. Socio-demographic, clinical, and medication information were retrieved and the present symptom severity was assessed by the Montgomery and Åsberg Depression Rating Scale (MADRS). The symptom improvement during the current MDD episode was covered by retrospective MADRS measurements. Beyond descriptive statistics, analyses of variance (ANOVA) and Spearman correlation analyses were accomplished to determine the influence of symptom severity and treatment response on the prescription patterns. 53.4% of all MDD patients received a selective serotonin reuptake inhibitor (SSRI) and 23.6% a serotonin-norepinephrine reuptake inhibitor (SNRI) as first-line treatment. The majority of participants (59.4%) were treated with polypharmaceutical strategies (median: 2 psychiatric compounds per patient) and for the number of individual drugs we found a significant correlation with the current MADRS total score and the MADRS total score change during the present depressive episode. Benzodiazepines (33.2% of patients), antidepressants (29.0%), antipsychotics (24.2%), and mood stabilizers (10.1%) were the most frequently prescribed adjunctive agents. There were no significant differences between the different psychopharmacological classes used as augmentors in terms of symptom severity and treatment response. In summary, this international cross-sectional study revealed the widespread use of polypharmaceutical treatment strategies in European tertiary psychiatric treatment centers for the management of MDD.
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Markus
M
Dold
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Alexander
A
Kautzky
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Lucie
L
Bartova
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Ulrich
U
Rabl
Université Libre de Bruxelles, Bruxelles, Belgium; Psy Pluriel Centre Européen de Psychologie Médicale, Bruxelles, Belgium.
Daniel
D
Souery
School of Medicine, Free University of Brussels, Bruxelles, Belgium.
Julien
J
Mendlewicz
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
Stefano
S
Porcelli
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
Alessandro
A
Serretti
Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Joseph
J
Zohar
Imperial College, University of London, London, United Kingdom.
Stuart
S
Montgomery
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. Electronic address: sci-biolpsy@meduniwien.ac.at.
Siegfried
S
Kasper
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017891:Pharmacoepidemiology; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012959:Socioeconomic Factors
D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors
Antidepressants; Antipsychotics; Augmentation; Depression; Mood stabilizers