BACKGROUND Understanding how patients are treated in the real-world is vital to identifying potential gaps in care. We describe the current pharmacologic treatment patterns for the treatment of depression. METHODS Patients with depression were identified from four large national claims databases during 1/1/2014-1/31/2019. Patients had ≥2 diagnoses for depression or an inpatient hospitalization with a diagnosis of depression. Patients were required to have enrollment in the database ≥1 year prior to and 3 years following their first depression diagnosis. Treatment patterns were captured at the class level and included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, and antipsychotics. Treatment patterns were captured during all available follow-up. RESULTS We identified 269,668 patients diagnosed with depression. The proportion not receiving any pharmacological treatment during follow-up ranged from 29 to 52%. Of the treated, approximately half received ≥2 different classes of therapy, a quarter received ≥3 classes and more than 10% received 4 or more. SSRIs were the most common first-line treatment; however, many patients received an anxiolytic, hypnotic/sedative, or antipsychotic prior to any antidepressive treatment. Treatment with a combination of classes ranged from approximately 20% of first-line therapies to 40% of fourth-line. CONCLUSIONS Many patients diagnosed with depression go untreated and many others receive a non-antidepressant medication class as their first treatment. More than half of patients received more than one type of treatment class during the study follow up, suggesting that the first treatment received may not be optimal for most patients.

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美国诊断为抑郁症的患者的治疗模式和药物治疗顺序：2014年至2019年。

背景技术了解患者在现实世界中的治疗方式对于确定潜在的医疗缺口至关重要。我们描述了当前用于治疗抑郁症的药物治疗模式。方法在2014年1月1日至2019年1月31日从四个大型国家索赔数据库中识别出抑郁症患者。患者被诊断出患有抑郁症≥2或住院并诊断为抑郁症。要求患者在首次抑郁诊断之前和之后≥3年入组数据库。在班级捕获了治疗方式，包括选择性5-羟色胺再摄取抑制剂（SSRI），5-羟色胺和去甲肾上腺素再摄取抑制剂，三环类抗抑郁药，其他抗抑郁药，抗焦虑药，催眠药/镇静药和抗精神病药。在所有可用的随访期间均记录了治疗方式。结果我们确定了269,668名被诊断为抑郁症的患者。随访期间未接受任何药物治疗的比例为29％至52％。在接受治疗的患者中，约有一半接受了≥2种不同的治疗，四分之一接受了≥3种治疗，超过10％的接受了4种或更多的治疗。SSRIs是最常见的一线治疗。但是，许多患者在进行任何抗抑郁治疗之前都接受了抗焦虑药，催眠药/镇静药或抗精神病药。一类疗法的组合治疗范围从一线疗法的大约20％到四线疗法的40％。结论许多被诊断为抑郁症的患者未经治疗，许多其他人接受了非抗抑郁药物治疗作为他们的第一个治疗方法。