Elsevier

Journal of Affective Disorders

Volume 290, 1 July 2021, Pages 334-344
Journal of Affective Disorders

Research paper
Real-world evidence from a European cohort study of patients with treatment resistant depression: Treatment patterns and clinical outcomes

https://doi.org/10.1016/j.jad.2021.03.073Get rights and content
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open access

Highlights

  • Real-world data on treatment resistant depression (TRD) in Europe are lacking

  • No treatment consensus has been reached; in this study, treatments varied widely

  • After 6 months of routine clinical care, 73.5% of patients had not responded

  • At Month (M) 6, 16.7% of patients were in remission but 33.3% lost remission by M12

  • Despite low remission rates, 60.0% of patients had not changed treatment at M12

Abstract

Background

Treatment resistant depression (TRD) characterizes a subgroup of 10–30% of patients with major depressive disorder, and is associated with considerable morbidity and mortality. A consensus treatment for TRD does not exist, which often leads to wide variations in treatment strategies. Real-world studies on treatment patterns and outcomes in TRD patients in Europe are lacking and could help elucidate current treatment strategies and their efficacy.

Methods

This non-interventional cohort study of patients with TRD (defined as treatment failure on ≥2 oral antidepressants given at adequate dose and duration) with moderate to severe depression collected real-world data on treatment patterns and outcomes in several European countries. Patients were started on a new treatment for depression according to routine clinical practice.

Results

Among 411 patients enrolled, after 6 months, only 16.7% achieved remission and 73.5% showed no response. At Month 12, while 19.2% achieved remission and 69.2% showed no response, 33.3% of those in remission at Month 6 were no longer in remission. Pharmacological treatments employed were heterogenous; 54 different drugs were recorded at baseline, and the top 5 treatment types according to drug classes accounted for 40.0% of patients. Even though remission rates were very low, at Month 12, 60.0% of patients had not changed treatment since enrolment.

Conclusions

The heterogeneity of treatments highlights a lack of consensus. Moreover, despite low response rates, patients often remained on treatments for substantial periods of time. These data further support existence of an unmet treatment need for TRD patients in Europe.

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