Abstract
Background: High sedative use in a major depressive episode may imply specific clinical features. This study aims to examine the correlation between sedative use and clinical severity indicators in the initial treatment phase of first-onset major depressive disorder.Methods: A study cohort in the first episode of major depressive disorder was used to conduct pharmacological dissection. All participants had at least a 2-year follow-up period with a complete treatment record. The defined daily dose of antidepressants and augmentation agents were calculated as the antidepressant load and augmentation load, respectively. Sedative use, which was calculated as the equivalent dosage of lorazepam, were defined as the sedative load. These psychotropic loads were measured monthly and the averaged psychotropic loads for each day were obtained.Results: A total of 106 individuals (75.5% female) were included. The mean duration of disease course in participants was 5.5 ± 3.5 years. In the multiple regression analysis, after controlling for other classes of psychotropics and comorbid anxiety disorders, the sedative load independently correlated with higher number of antidepressants used, higher number of antidepressant used with an adequate dose and duration, more psychiatric emergency and outpatient visits within 2 years of disease onset.Conclusion: High loading of sedatives correlated with several indicators of clinical severity in major depressive disorder. The sedative load may be used as a specifier to identify subgroups in patients with major depressive disorder.
Highlights
The high heterogeneity of major depressive disorder (MDD) imposes complexities on sub-grouping treatment response [1], impacts the study of endophenotype and genotype indirectly [2,3,4], and further compromises delivery of specific antidepressant treatment
There were no significant differences between gender on antidepressant load (ADL), augmentation load (AUGL) (daily average of female: 0.05 ± 0.10, male: 0.03 ± 0.06; TABLE 1 | Demographic and clinical characteristics of participants (n = 106)
With regards to the relationship between psychotropic loads with clinical severity indicators more than 2 years after disease onset (Table 4), the results show that the ADL independently predicted the number of psychiatric admissions [IRR (95%CI): 3.72 (1.15–12.03), p = 0.03], psychiatric outpatient use [IRR (95%CI): 1.25 (1.19–1.31), p ≤ 0.001] and severity of depressive symptoms at the end of follow-up [b = 0.50 (0.19), p = 0.01]
Summary
The high heterogeneity of major depressive disorder (MDD) imposes complexities on sub-grouping treatment response [1], impacts the study of endophenotype and genotype indirectly [2,3,4], and further compromises delivery of specific antidepressant treatment. More than half of patients with MDD have a comorbid anxiety disorder [7, 8]. Patients with MDD and concurrent anxiety symptoms have poorer treatment responses [9,10,11], longer disease course [11,12,13,14], and higher suicidality [13, 15]. Sleep disturbance is a commonly co-occurring symptom of MDD [16]. About 80% patients with MDD have concurrent sleep disturbance. The co-occurrence of anxiety symptoms and sleep disturbance with MDD are of particular clinical importance. This study aims to examine the correlation between sedative use and clinical severity indicators in the initial treatment phase of first-onset major depressive disorder
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