Objective

: To describe treatment patterns in patients with treatment-resistant depression (TRD) and major depressive disorder (MDD) stratified by depression severity and year of diagnosis. Patterns of treatment were also compared to country-specific guidelines.

Methods

: All adults registered first time with a hospital contact due to MDD from 1996 through 2015 were identified and followed for all dispensed prescriptions of antidepressants, antipsychotics, lithium, initiation of electroconvulsive therapy (ECT), and psychotherapy in Danish registers 12 months before and after their hospital MDD diagnosis. TRD was characterized by two shifts in treatment.

Results

: We identified 197,615 patients of whom 15% developed TRD. In total, 88% of patients started treatment with antidepressants or ECT. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently used treatment during the study period and more than half (50.7%) of patients changed treatment at least once. Among patients with TRD, serotonin and noradrenaline reuptake inhibitors (SNRIs) were the most frequently used treatment (55.9%), and 37.0% initiated a new treatment the following year. SSRIs and SNRIs were part of most combinations of treatment, regardless of depression severity, year of diagnosis, or presence of TRD.

Conclusion

: 15% of patients met the criteria for TRD. Irrespective of patient characteristics and year of diagnosis, SSRIs and SNRIs are the most used treatments for depression, even after patients met the criteria for TRD. We confirm that guidelines for first treatment were followed for most patients diagnosed with MDD in Denmark, but for patients with TRD, choice of treatment was arbitrary.

中文翻译：

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丹麦重度抑郁症患者的难治性抑郁症患者的治疗方式

客观的

：描述按抑郁症严重程度和诊断年份分层的抗抑郁药（TRD）和重度抑郁症（MDD）患者的治疗方式。还将治疗方式与国家特定指南进行了比较。

方法

：在1996年至2015年期间，确定了所有因1996年至2015年首次因MDD首次就医的人，并在丹麦注册的所有抗抑郁药，抗精神病药，锂，开始电痉挛治疗（ECT）和心理治疗处方药他们医院的MDD诊断。TRD的特征是治疗发生了两次转变。

结果

：我们确定了197,615例患者，其中15％患有TRD。总共有88％的患者开始使用抗抑郁药或ECT治疗。选择性5-羟色胺再摄取抑制剂（SSRIs）是研究期间最常用的治疗方法，一半以上（50.7％）的患者至少改变了一次治疗方法。在TRD患者中，最常用的治疗方法是血清素和去甲肾上腺素再摄取抑制剂（SNRIs）（55.9％），第二年有37.0％的患者开始新的治疗方法。SSRI和SNRI是大多数治疗组合的一部分，而与抑郁症的严重程度，诊断年份或是否存在TRD无关。

结论

： 15％的患者符合TRD标准。无论患者的特征和诊断年份如何，SSRI和SNRI都是抑郁症最常用的治疗方法，即使患者符合TRD标准。我们确认，在丹麦，大多数诊断为MDD的患者都遵循了首次治疗的指南，但是对于TRD的患者，治疗的选择是任意的。