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Guideline adherence of antidepressant treatment in outpatients with major depressive disorder: a naturalistic study

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Abstract

Little is known about guideline adherence of naturalistic antidepressant drug therapy in outpatients with major depressive disorder (MDD). The aim of the study was to analyze guideline adherence, especially regarding treatment length, treatment evaluation and medication change strategies. We investigated 889 patients with MDD who had been admitted for inpatient treatment and were enrolled in the early medication change trial (ClinicalTrials.gov NCT00974155). We investigated all patients at screening visit regarding previous outpatient drug treatment in the index episode, which was assessed by structured interviews. Demographic variables were obtained from patients and patients’ records. 51.0% of the patients had received previous drug treatment in the index episode, 56.6% were females, and their mean age was 40.0 years. In the 153 patients who were pharmacologically treated at least 8 weeks, medication was not changed in 129 (84.3%) patients. Patients who had a medication change in their index episode (n = 24, 15.7%) waited 71.1 weeks (±110.4) for their treatment optimization. Only 5 of those 153 patients (3.3%) had a dose increase, whereas 132 patients (86.3%) had no dose adaption at all. Antidepressant blood levels were measured in 46 patients (30.1%). We conclude that a large proportion of patients with MDD is not treated in adherence to treatment guidelines recommending treatment evaluation (e.g. therapeutic drug monitoring) and treatment change after 4 to 8 weeks in non-responders. Earlier treatment optimization may prevent long-term suffering of patients and may avoid inpatient treatment.

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Acknowledgements

The EMC trial (ClinicalTrials.gov Identifier: NCT00974155) was supported by Grant No. 01KG0906 from the German Federal Ministry for Education and Research (BMBF). The BMBF had no role in trial design, data collection, data analysis, data interpretation, or writing of the report. We are grateful to all patients who contributed to this study and to our clinical study members for their work. This includes especially Stefan Elsner, MD (Hospital for Psychiatry and Psychotherapy, Andernach), Julia Reiff, MD (Hospital for Psychiatry and Psychotherapy, Wiesbaden), Joachim Röschke, MD, PhD (Hospitals for Psychiatry and Psychotherapy, Bad Soden and Kiedrich), Ömür Baskaya, MD, Markus Lorscheider, MD, and Alexander Teml, MD (University Medical Center Mainz, Department of Psychiatry and Psychotherapy). We are also grateful to Armin Szegedi and Rolf Meinert (both formerly affiliated to University Medical Center Mainz), who participated in an early study phase of design development as well as to the members of the Data and Safety Monitoring Board (Walter Lehmacher, Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne; Ulrich Hegerl, Department of Psychiatry and Psychotherapy, University of Leipzig; Ekkehard Haen, Department of Psychiatry and Psychotherapy, University of Regensburg).

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany

    David P. Herzog, Stefanie Wagner, André Tadic & Klaus Lieb

  2. Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Christian Ruckes

  3. Hospital for Psychiatry and Psychotherapy, Vitos Rheingau, Kloster-Eberbach-Straße 4, 65346, Eltville, Germany

    Sibylle C. Roll

  4. Department of Psychiatry, Psychosomatics and Psychotherapy, Agaplesion Elisabethenstift gGmbH, 64287, Darmstadt, Germany

    André Tadic

  5. Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Martin Härter

Authors
  1. David P. Herzog
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  2. Stefanie Wagner
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  3. Christian Ruckes
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  4. André Tadic
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  5. Sibylle C. Roll
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  6. Martin Härter
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  7. Klaus Lieb
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Corresponding authors

Correspondence to David P. Herzog or Klaus Lieb.

Ethics declarations

All participants gave their written informed consent to participate in the study after a complete and extensive description. All study components were approved by the local ethical committee of the Landesärztekammer Rheinland-Pfalz (study code no: 837.166.09 (6671)) and are compliant with the Code of Ethics of the World Medical Association (Declaration of Helsinki).

Conflict of interest

Dr. Tadic has received consultancy fees from Janssen and Novartis. Prof. Roll has received lecture fees by Boehringer Ingelheim, Lundbeck, and Otsuka. All other authors report no conflict of interest.

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Herzog, D.P., Wagner, S., Ruckes, C. et al. Guideline adherence of antidepressant treatment in outpatients with major depressive disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci 267, 711–721 (2017). https://doi.org/10.1007/s00406-017-0798-6

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  • DOI: https://doi.org/10.1007/s00406-017-0798-6

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