Abstract
BackgroundThere is a knowledge gap regarding the treatment patterns of patients with major depressive disorder (MDD) who experience suicidal ideation or a suicide attempt (SI/SA).MethodsPatients with SI/SA were identified from a large US-based claims database covering 84 million lives, during 1/1/2014–3/31/2020. Patients with MDD were indexed at their first diagnosis for SI/SA and followed up to 365 days. Treatment patterns were captured at the class level and included procedures of electroconvulsive therapy and transcranial magnetic stimulation, and pharmacotherapy including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, antipsychotics, psychostimulants, and lithium.ResultsThere were 42,204 MDD + SI/SA patients identified. In the year prior to the index event > 40% of individuals received an SSRI and more than one-third received an anxiolytic. Within 1 year following, 84.4% received ≥1 of the treatments of interest. Of those, 70.2% went on to a subsequent class-based regimen, 46.3% received a third, and 28.1% received ≥4. More than three-quarters of patients received multiple treatment classes simultaneously. SSRIs were the most common treatments during follow-up (61.9%), followed by other antidepressants (51.3%), anxiolytics (50.8%) and anticonvulsants (43.6%).ConclusionsThere was a large amount of variability and polypharmacy in the treatments received by MDD patients with SI/SA, and is much more complex than what has been previously observed in the general MDD population. Within one-year, many patients received four or more unique class-based regimens and most patients received treatments from multiple classes simultaneously, indicating the high unmet medical need and therapy refractoriness of this patient population.
Highlights
There is a knowledge gap regarding the treatment patterns of patients with major depressive disorder (MDD) who experience suicidal ideation or a suicide attempt (SI/Suicide attempt (SA))
Treatment patterns Treatment patterns were captured at the class level and included the pharmacotherapies of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), other antidepressants, anxiolytics, hypnotics/sedatives, antipsychotics, psychostimulants and lithium; and procedures of electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS)
Anxiety disorder was diagnosed in more than 40% of patients during the baseline period, while conditions related to pain, substance use disorder, insomnia, and cardiovascular disease were prevalent
Summary
There is a knowledge gap regarding the treatment patterns of patients with major depressive disorder (MDD) who experience suicidal ideation or a suicide attempt (SI/SA). The treatment of patients with depression with suicidal ideation or suicidal attempts is challenging due to the urgency of the condition, the need to for immediate interventions to save lives and the limited treatment options. Patients with suicidality suffer from poorer quality of life and social functioning than patients with MDD without suicidality [10,11,12]. Treating MDD patients contemplating suicide is a complicated problem that requires physicians to treat not just the depression, or to consider these patients as having a severe subtype of major depression, but instead to consider the suicidality itself as a distinct condition which warrants its own consideration [13]. In addition to finding an intervention that works quickly and effectively, it’s important for the clinician to understand why the patient wishes to commit suicide and create a trusting bond between the patient and the physician [14]
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