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BMC Psychiatry
Published in: BMC Psychiatry 1/2023

Open Access 01-12-2023 | Antidepressant Drugs | Research

Prospective study of antidepressant treatment of psychiatric patients with depressive disorders: treatment adequacy and outcomes

Authors: Johanna von Knorring, Ilya Baryshnikov, Pekka Jylhä, Tiina Talaslahti, Martti Heikkinen, Erkki Isometsä

Published in: BMC Psychiatry | Issue 1/2023

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Abstract

Background

Despite numerous national depression care guidelines (DCGs), suboptimal antidepressant treatment may occur. We examined DCG concordance and depression treatment outcomes in psychiatric settings.

Methods

We evaluated treatment received and outcomes of 128 psychiatric out- and inpatients participating in the PEGAD (Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders) study at baseline, two weeks, and eight weeks using interviews and questionnaires. Inclusion criteria were ICD-10 diagnosis of a depressive disorder, a Patient Health Questionnaire-9 symptom (PHQ-9) score ≥ 10, and a new antidepressant prescribed. The primary outcome of the study was within-individual change in PHQ-9 scores.

Results

At baseline, patients had predominately recurrent (83%) and in 19% treatment-resistant depression (TRD). The median preceding duration of the current episode was 6.5 months. At eight weeks, 85% of the patients (n = 107) used a DCG-concordant antidepressant dose. However, due to the scarcity of antidepressant combinations and augmentations, fewer TRD than non-TRD patients (25% vs. 84%, p < 0.005) received adequate antidepressant treatment. Additionally, one-third of the patients received inadequate follow-up. Overall, only 53% received treatment compatible with DCG recommendations for adequate pharmacotherapy and follow-up. The mean decline in PHQ-9 scores (-3.8 ± SD 5.7) was significant (p < 0.0005). Nearly 40% of the patients reached a subthreshold level of depression (PHQ-9 < 10), predicted by a lower baseline PHQ-9 score, recurrent depression, and female sex. However, 45% experienced no significant clinical improvement (PHQ-9 score reduction < 20%).

Conclusions

Our findings suggest that inadequate treatment continues to occur in psychiatric care settings, particularly for TRD patients.
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Metadata
Title
Prospective study of antidepressant treatment of psychiatric patients with depressive disorders: treatment adequacy and outcomes
Authors
Johanna von Knorring
Ilya Baryshnikov
Pekka Jylhä
Tiina Talaslahti
Martti Heikkinen
Erkki Isometsä
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2023
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-023-05390-8

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