Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the USA
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Major depressive disorder (MDD) is a debilitating illness in which depressive symptoms may persist after treatment. Treatment inertia is the continued use of the same pharmacotherapy regimen when treatment goals are not met. This study assessed the frequency of treatment inertia among adult patients with MDD treated in a real-world setting. Patients & methods: This was a retrospective, observational study of patients with MDD identified in the Decision Resources Group Real World Evidence US Data Repository from January 2014 to June 2018. Patients (≥18 years) had an elevated Patient Health Questionnaire-9 (PHQ-9) score (≥5) following 8 weeks of stable baseline antidepressant use with/without mental-health outpatient therapy. Treatment inertia, modification and discontinuation were evaluated over a 16-week follow-up period (timeline based on the APA Practice Guidelines). The primary outcome was the proportion of MDD patients experiencing treatment inertia. Results: 2850 patients (median age, 55 years; 74% female) met the study criteria. Of these patients, 834 (29%) had study-defined treatment inertia, 1534 (54%) received treatment modification and 482 (17%) discontinued treatment. Use of mirtazapine (Odd ratio [OR]: 0.63; 95% confidence interval [CI]: 0.50–0.79), selective serotonin reuptake inhibitors (OR: 0.64; 95% CI: 0.54–0.75) or bupropion (OR: 0.71; 95% CI: 0.60–0.84) in the baseline period was associated with an increased likelihood of treatment modification versus not receiving treatment with these medications. Frequency of treatment inertia may differ among those who do not have a documented PHQ-9 score. Conclusion: Effective symptom management is critical for optimal outcomes in MDD. Results demonstrate that treatment inertia is common in MDD despite guidelines recommending treatment modification in patients not reaching remission.
Tweetable abstract
This real-world, observational study showed that treatment inertia (continued use of the same treatment when remission goals are not met) is common in major depressive disorder, occurring in about 1 in 3 patients with unresolved symptoms.
Plain language summary
Major depressive disorder (MDD) is a mental illness. Treatment for MDD typically involves medications. Some people do not respond to initial treatment but continue to use the same medication. This is called treatment inertia. We assessed the real-world frequency of treatment inertia among patients with MDD. Despite treatment modification guidance, treatment inertia is common in MDD, affecting 29% of patients surveyed.
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© 2023 Becaris Publishing Limited. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
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Received: 8 June 2023
Accepted: 31 October 2023
Published online: 21 November 2023
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Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the USA. (2023) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2023-0091
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