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. 2022 Jun;272(4):715-727.
doi: 10.1007/s00406-021-01368-3. Epub 2022 Jan 6.

The sociodemographic and clinical profile of patients with major depressive disorder receiving SSRIs as first-line antidepressant treatment in European countries

Gernot Fugger #  1   2 , Lucie Bartova #  1   2 , Chiara Fabbri  2   3 , Giuseppe Fanelli  2   4 , Markus Dold  1 , Marleen Margret Mignon Swoboda  1 , Alexander Kautzky  1 , Joseph Zohar  5 , Daniel Souery  6   7 , Julien Mendlewicz  6 , Stuart Montgomery  8 , Dan Rujescu  1 , Alessandro Serretti  2 , Siegfried Kasper  9   10
Affiliations

The sociodemographic and clinical profile of patients with major depressive disorder receiving SSRIs as first-line antidepressant treatment in European countries

Gernot Fugger et al. Eur Arch Psychiatry Clin Neurosci. 2022 Jun.

Abstract

Introduction: Due to favorable antidepressant (AD) efficacy and tolerability, selective-serotonin reuptake inhibitors (SSRIs) are consistently recommended as substances of first choice for the treatment of major depressive disorder (MDD) in international guidelines. However, little is known about the real-world clinical correlates of patients primarily prescribed SSRIs in contrast to those receiving alternative first-line ADs.

Methods: These secondary analyses are based on a naturalistic, multinational cross-sectional study conducted by the European Group for the Study of Resistant Depression at ten research sites. We compared the socio-demographic and clinical characteristics of 1410 patients with primary MDD, who were either prescribed SSRIs or alternative substances as first-line AD treatment, using chi-squared tests, analyses of covariance, and logistic regression analyses.

Results: SSRIs were prescribed in 52.1% of MDD patients who showed lower odds for unemployment, current severity of depressive symptoms, melancholic features, suicidality, as well as current inpatient treatment compared to patients receiving alternative first-line ADs. Furthermore, patients prescribed SSRIs less likely received add-on therapies including AD combination and augmentation with antipsychotics, and exhibited a trend towards higher response rates.

Conclusion: A more favorable socio-demographic and clinical profile associated with SSRIs in contrast to alternative first-line ADs may have guided European psychiatrists' treatment choice for SSRIs, rather than any relevant pharmacological differences in mechanisms of action of the investigated ADs. Our results must be cautiously interpreted in light of predictable biases resulting from the open treatment selection, the possible allocation of less severely ill patients to SSRIs as well as the cross-sectional study design that does not allow to ascertain any causal conclusions.

Keywords: Antidepressant treatment; Antidepressants; Major depressive disorder; Selective-serotonin reuptake inhibitors.

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Conflict of interest statement

Dr. Bartova has received travel grants and consultant/speaker honoraria from AOP Orphan, Medizin Medien Austria, Vertretungsnetz, Schwabe Austria, Janssen and Angelini. Dr. Fugger has received consultant/speaker honoraria from Janssen. Dr. Dold has received travel grants and consultant/speaker honoraria from Janssen-Cilag. Dr. Zohar has received grant/research support from Lundbeck, Servier, and Pfizer; he has served as a consultant or on the advisory boards for Servier, Pfizer, Solvay, and Actelion; and he has served on speakers’ bureaus for Lundbeck, GlaxoSmithKline, Jazz, and Solvay. Dr. Mendlewicz is a member of the board of the Lundbeck International Neuroscience Foundation and of the advisory board of Servier. Dr. Souery has received grant/research support from GlaxoSmithKline and Lundbeck; and he has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Lundbeck. Dr. Montgomery has served as a consultant or on advisory boards for AstraZeneca, Bionevia, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Grunenthal, Intellect Pharma, Johnson & Johnson, Lilly, Lundbeck, Merck, Merz, M's Science, Neurim, Otsuka, Pierre Fabre, Pfizer, Pharmaneuroboost, Richter, Roche, Sanofi, Sepracor, Servier, Shire, Synosis, Takeda, Theracos, Targacept, Transcept, UBC, Xytis, and Wyeth. Dr. Fabbri has been supported by Fondazione Umberto Veronesi (https://www.fondazioneveronesi.it). Dr. Serretti has served as a consultant or speaker for Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, and Servier. Within the last three years, Dr. Kasper received grants/research support, consulting fees, and/or honoraria from Angelini, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Mundipharma, Neuraxpharm, Pfizer, Sanofi, Schwabe, Servier, Shire, Sumitomo Dainippon Pharma Co. Ltd., sun Pharma and Takeda. All other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Individual substances administered in 734 MDD patients treated with SSRIs as their first-line AD treatment. Displayed cumulative percentages refer to the individual SSRIs administered as first-line AD treatment in 734 MDD patients. AD antidepressant, MDD major depressive disorder, SSRIs selective serotonin reuptake inhibitors
Fig. 2
Fig. 2
The current suicidal risk of MDD patients receiving either SSRIs or other substances as their first-line AD treatment. Displayed cumulative percentages refer to the proportion of MDD patients receiving either SSRIs (n = 737; 52.1%; red colored) or alternative substances (n = 676; 47.9%; blue colored) as their first-line AD treatment itemized according to the current suicidal risk and its extent that were ascertained according to the HAM-D item 3 that is exclusively dedicated to suicidality [17]. While the absence of the current suicidal risk was reflected by the item-score of 0 (absent), its presence was represented by item-scores of 1 (feels life is not worth living), 2 (wishes to be dead or any thoughts of possible death to self), 3 (suicide ideas or gestures) or 4 (suicide attempts). While significant between-group differences were detected in terms of the presence of the current suicidal risk (p < 0.001), MDD patients receiving first-line SSRIs did not significantly differ from their counterparts with respect to its extent (p = 0.214). AD antidepressant, HAM-D Hamilton Depression Rating Scale, MDD major depressive disorder, SSRIs = selective serotonin reuptake inhibitors
Fig. 3
Fig. 3
Treatment outcome patterns in MDD patients receiving either SSRIs or other substances as their first-line AD treatment. Displayed cumulative percentages refer to the proportion of MDD patients receiving either SSRIs (n = 737; 52.1%; red colored) or alternative substances (n = 676; 47.9%; blue colored) as their first-line AD treatment itemized according to their treatment outcome patterns reflecting response, non-response and TRD that differed significantly between both patient groups in our initial analyses (p < 0.001). While non-response was defined by a previous single failed AD trial, at least two failed AD trials were mandatory for TRD. AD antidepressant; MDD major depressive disorder; SSRIs selective serotonin reuptake inhibitors, TRD treatment resistant depression
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References

    1. Akiskal HS, Benazzi F, Perugi G, Rihmer Z. Agitated "unipolar" depression re-conceptualized as a depressive mixed state: Implications for the antidepressant-suicide controversy. J Affect Disord. 2005;85:245–258. doi: 10.1016/j.jad.2004.12.004. - DOI - PubMed
    1. Ball S, Classi P, Dennehy EB. What happens next? A claims database study of second-line pharmacotherapy in patients with major depressive disorder (mdd) who initiate selective serotonin reuptake inhibitor (SSRI) treatment. Ann Gen Psychiatry. 2014;13:8. doi: 10.1186/1744-859X-13-8. - DOI - PMC - PubMed
    1. Bartova L, Dold M, Kautzky A, Fabbri C, Spies M, Serretti A, Souery D, Mendlewicz J, Zohar J, Montgomery S, Schosser A, Kasper S. Results of the european group for the study of resistant depression (gsrd)—basis for further research and clinical practice. World J Biol Psychiatry. 2019;20:427–448. doi: 10.1080/15622975.2019.1635270. - DOI - PubMed
    1. Bartova L, Fugger G, Dold M, Swoboda MMM, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disorder—evidence from the european group for the study of resistant depression. J Psychiatr Res. 2021;141:167–175. doi: 10.1016/j.jpsychires.2021.06.028. - DOI - PubMed
    1. Bauer M, Severus E, Möller HJ, Young AH, WFSBP Task Force on Unipolar Depressive Disorders (2017) Pharmacological treatment of unipolar depressive disorders: summary of WFSBP guidelines. Int J Psychiatry Clin Pract 21(3):166–176 - PubMed

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