Abstract
IntroductionDue 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.MethodsThese 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.ResultsSSRIs 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.ConclusionA 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.
Highlights
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
Selective-serotonin reuptake inhibitors (SSRIs) represent a very well studied class of antidepressant (AD) medication that is consistently recommended as the first-line psychopharmacotherapy for major depressive disorder (MDD) in clinical practice guidelines (CPG) throughout the world [25]
The total sample included 1410 MDD patients [3] who were treated with either SSRIs (n = 734, 52.1%) or other AD substances (n = 676, 47.9%) including serotonin and norepinephrine reuptake inhibitors (SNRIs) (n = 336), noradrenergic-dopamine reuptake inhibitors (NDRIs; n = 32), noradrenergic and specific serotonergic AD (NaSSA) (n = 121), serotonin antagonist and reuptake inhibitors (SARIs; n = 28), noradrenaline reuptake inhibitors (NARIs; n = 3), tricyclic ADs (TCAs) (n = 74), monoamine oxidase inhibitors (MAOIs; n = 5), agomelatine (n = 69), tianeptine (n = 2), and vortioxetine (n = 6) as their first-line AD psychopharmacotherapy during their current major depressive episode (MDE)
Summary
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. Conclusion A more favorable socio-demographic and clinical profile associated with SSRIs in contrast to alternative firstline 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. Selective-serotonin reuptake inhibitors (SSRIs) represent a very well studied class of antidepressant (AD) medication that is consistently recommended as the first-line psychopharmacotherapy for major depressive disorder (MDD) in clinical practice guidelines (CPG) throughout the world [25]. As for individual SSRIs, escitalopram, citalopram, sertraline, and fluoxetine exhibited the lowest drop-out rates, while fluvoxamine the highest [11]
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