Pharmacological treatment strategies in unipolar depression in European tertiary psychiatric treatment centers - A pharmacoepidemiological cross-sectional multicenter study

Abstract

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.

Keywords: Antidepressants; Antipsychotics; Augmentation; Depression; Mood stabilizers.