Neuropsychiatric Disease and Treatment (Oct 2022)

Measuring Response to Adjunctive Therapy Among Individuals with Major Depressive Disorder

  • Forma F,
  • Liberman JN,
  • Rui P,
  • Wiggins E,
  • Ruetsch C

Journal volume & issue
Vol. Volume 18
pp. 2467 – 2475

Abstract

Read online

Felicia Forma,1 Joshua N Liberman,2 Pinyao Rui,2 Emily Wiggins,2 Charles Ruetsch2 1Health Economics & Real-World Evidence, Formerly Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA; 2Health Analytics, LLC, Columbia, MD, USACorrespondence: Joshua N Liberman, Tel +1 410-997-3314, Email [email protected]: Incomplete or inadequate response to first-line antidepressant therapy (ADT) for major depressive disorder (MDD) is common. Response to adjunctive therapy is less understood.Objective: To estimate response to adjunctive pharmacotherapy or psychotherapy among individuals with MDD on an antidepressant using the PHQ-9 questionnaire.Methods: This was a retrospective cohort analysis using medical and pharmacy insurance claims among individuals with MDD or ADT who initiated adjunctive pharmacotherapy, psychotherapy, or both (dual). Eligible individuals initiated adjunctive therapy between 7/1/2014-12/31/2018. Symptom severity was measured by PHQ-9 score in the 6-month baseline and 12-month follow up. Multivariate logistic regression identified factors associated with improved symptom severity.Results: Most (81.8%) of the 2389 participants initiated adjunctive pharmacotherapy, followed by psychotherapy (12.7%) and dual adjunctive (5.5%). Only 30.2% had both a baseline and follow-up PHQ-9 score. Among those with mild or more severe PHQ-9 baseline scores, 36.7% had the same or worse MDD severity during follow-up. Among those with moderate or more severe baseline scores, 28.1% had the same or worse MDD severity during follow-up.Conclusion: Most individuals with moderate-to-severe MDD did not receive a follow-up questionnaire, suggesting incomplete monitoring of treatment response. Among those with a PHQ-9 following initiation of adjunctive therapy, many continued to report impactful symptoms. Future studies should explore alternate treatment approaches and methods to support the utilization of the PHQ-9 for monitoring treatment response.Keywords: major depressive disorder, adjunctive therapy, PHQ-9, measurement-based care, psychotherapy

Keywords