Characteristics and current standard of care among veterans with major depressive disorder in the United States: A real-world data analysis

• Published in: Journal of affective disorders Vol. 307; pp. 184 - 190
• Main Authors: Zhao, Xiaohui, Karkare, Swapna, Nash, Abigail I., Sheehan, John J., Aboumrad, Maya, Near, Aimee M., Banerji, Tania, Joshi, Kruti
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.06.2022
• Subjects: Adult; Aged; Antidepressive Agents - therapeutic use; Data Analysis; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - epidemiology; Female; Humans; Line of therapy; Major depressive disorder; Male; Medicare; Middle Aged; Real-world data analysis; Retrospective Studies; Standard of Care; Treatment-resistant depression; United States - epidemiology; Veterans; United States; Line of therapy; Real-world data analysis; Veterans; Standard of care; Major depressive disorder; Treatment-resistant depression
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2022.03.058

This study examined MDD treatment regimens received during the first observed and treated major depressive episode (MDE) among US veterans. This retrospective study, conducted using the Veterans Health Administration (VHA) database, supplemented with Medicare Part A/B/D data, included adults with ≥1 MDD diagnosis (index date) between 10/1/2015–2/28/2017 and ≥1 line of therapy (LOT) within the first observed complete MDE. Patient baseline (6-month pre-index) characteristics and up to six LOTs received during the first observed and treated MDE were assessed. Of 40,240 veterans with MDD identified (mean age: 50.9 years, 83.9% male, 63.4% White, 88.6% non-Hispanic), hypertension (27.5%), hyperlipidemia (20.8%), and post-traumatic stress disorder (17.5%) were the most common baseline comorbidities. During the first observed and treated MDE, patients received a mean of 1.6 ± 1.0 LOTs, with 14.6% of patients receiving ≥3 LOTs. SSRI-monotherapy was the most commonly observed regimen in the first six LOTs, followed by SNRI-monotherapy in LOT 1 and antidepressants augmented by anticonvulsants in the remaining five LOTs. The antidepressant class of the previous LOT was commonly used in the subsequent LOT. SSRI-SSRI-SSRI was the most common LOT1-to-LOT3 sequencing pattern among patients receiving ≥3 LOTs. The study findings are limited to data in the VHA database and may not be generalizable to the non-veteran US population. During the first observed and treated MDE, SSRI-monotherapy was the most common therapy in the first six LOTs. Cycling within SSRI class was the leading sequencing pattern of the first three LOTs among veterans who received ≥3 LOTs. •Veterans' real-world treatments for major depressive disorder (MDD) were assessed.•SSRI monotherapy was the most commonly used treatment in all lines of therapy.•The antidepressant class in the previous line of therapy was commonly used in the subsequent line.•One in seven veterans with MDD may be considered to have treatment-resistant depression.