title: Major depressive disorder with subthreshold hypomanic (mixed) features: A real-world assessment of treatment patterns and economic burden.
abstract: To compare outcomes for individuals with major depressive disorder (MDD) with or without subthreshold hypomania (mixed features) in naturalistic settings.
  
  
  
  Using the Optum Research Database (1/1/2009─10/31/2014), a retrospective analysis of individuals newly diagnosed with MDD was conducted. Continuous enrollment for 12-months before and after the initial MDD diagnosis was required. MDD with subthreshold hypomania (mixed features) (MDD-MF) was defined based on ≥1 hypomania diagnosis within 30 days after an MDD diagnosis during the one-year follow-up period, in the absence of bipolar I diagnoses. Psychiatric medication use, healthcare utilization, and costs during the one-year follow-up period were compared using multivariate logistic and gamma regressions, controlling for baseline differences.
  
  
  
  Of 130,626 MDD individuals, 652 (0.5%) met the operational definition of MDD-MF. Compared to the MDD-only group, the MDD-MF group had more suicidality (2.0% vs. 0.5%), anxiety disorders (46.8% vs. 34.0%), and substance use disorders (15.5% vs. 6.1%, all P<0.001). More individuals with MDD-MF were treated with antidepressants (83.6% vs. 71.6%), mood stabilizers (50.5% vs. 2.7%), atypical antipsychotics (39.0% vs. 5.5%), and polypharmacy with multiple drug classes (72.1% vs. 22.7%, all P<0.001). Individuals with MDD-MF had higher hospitalizations rates (24.2% vs. 10.5%) and total healthcare costs (mean: $15,660 vs. $10,744, all P<0.001).
  
  
  
  The commercial claims data used were not collected for research purposes and may over- or under-represent certain populations. No specific claims-based diagnostic code for MDD with mixed features exists.
  
  
  
  Greater use of mood stabilizers, atypical antipsychotics, polypharmacy, and healthcare resources provides evidence of the complexity and severity of MDD-MF. Identifying optimal treatment regimens for this population represents a major unmet medical need.
authors.affiliation: University of Toronto, MDPU-BCDF, Toronto, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.affiliation: Sunovion Pharmaceuticals Inc., Marlborough, MA, USA. Electronic address: Daisy.Ng-Mak@Sunovion.Com.
authors.forename: Daisy
authors.initials: D
authors.lastname: Ng-Mak
authors.affiliation: Vertex Pharmaceuticals Inc., Boston, MA, USA.
authors.forename: Chien-Chia
authors.initials: CC
authors.lastname: Chuang
authors.affiliation: Optum, Prairie, MN, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Halpern
authors.affiliation: Kantar Health, New York, NY, USA.
authors.forename: Pankaj A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
authors.forename: Krithika
authors.initials: K
authors.lastname: Rajagopalan
authors.affiliation: Sunovion Pharmaceuticals Inc., Fort Lee, NY, USA.
authors.forename: Antony
authors.initials: A
authors.lastname: Loebel
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000209:etiology; D001714:Bipolar Disorder / Q000150:complications / Q000191:economics / Q000523:psychology* / Q000628:therapy; D017281:Cost of Illness; D003865:Major Depressive Disorder / Q000150:complications / Q000191:economics / Q000523:psychology* / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000209:etiology
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Drug utilization; Health services research; Healthcare administrative claims; Major depressive disorder; Major depressive disorder with mixed features; Mood disorders