Major Depressive Disorder Population Research Articles

The direct costs of untreated comorbid insomnia in a managed care population with major depressive disorder

Objectives:Previous research has shown that untreated insomnia has significant direct and indirect burden. Despite the high comorbidity of insomnia and Major Depressive Disorder (MDD), no studies have attempted to determine the economic costs among patients diagnosed with MDD and insomnia. The purpose of this study was to estimate the economic burden of comorbid untreated insomnia within an adult and elderly population with MDD.Design:A retrospective, observational study comparing direct health care costs in insomnia patients with MDD to a matched non-insomniacs group with MDD that had MDD and no insomnia. Data was from taken from managed care claims database in the United States.Measurements and results:A large managed care claims database was used to identify MDD subjects (aged ≥18 years) anytime between 01/01/1998 to 11/30/2007 using MDD-specific ICD-9-CM diagnoses. Insomniacs with MDD (n = 38,213) were selected from this cohort using insomnia-specific ICD-9-CM codes or hypnotic use. Costs were calculated for the twelve months prior to initiating insomnia treatment/diagnosis. Direct costs were compared with 1:1 matched non-insomniacs with MDD. Total direct costs included inpatient, outpatient, emergency room (ER) and drug costs. Cost outcomes were analyzed using a generalized linear model with gamma distribution and log link, and GEE estimation. Insomniacs with MDD had statistically greater (p < 0.01) total outpatient visits 8.34 (SE = 0.04) vs non-insomniacs with MDD 7.26 (SE = 0.04); MDD-related visits 3.9 (SE = 0.04) vs non-insomniacs with MDD 2.1 (SE = 0.02); and antidepressant prescriptions 5.0 (SE = 0.03) vs non-insomniacs with MDD 4.2 (SE = 0.03). Overall direct costs for insomniacs with MDD were significantly (p < 0.001) higher than non-insomniacs with MDD ($4858 vs $4007). Similar direct cost differences ($1007) were found in a sample of elderly (aged ≥65 years) patients (n = 2756) mean age = 75.6 yrs.Conclusions:Untreated insomnia within an adult and elderly comorbid MDD population is associated with higher MDD-related and overall direct costs compared to MDD without insomnia. Key limitations associated with this study make it likely that the direct costs and appearance of comorbidities may have been underestimated. These include that: the non-insomnia with MDD group may have untreated/undiagnosed insomnia; some identified cases were likely treated with over-the-counter or behavioral treatment; and that other drugs may have been used for insomnia were not considered for this study and may have been taken for another condition. Future research needs to determine whether treating comorbid insomnia within a MDD population is cost-effective.

Simultaneous initiation (coinitiation) of pharmacotherapy with triiodothyronine and a selective serotonin reuptake inhibitor for major depressive disorder: a quantitative synthesis of double-blind studies

To examine the efficacy and overall tolerability of the simultaneous initiation of treatment (coinitiation) with triiodothyronine (T3) and a selective serotonin reuptake inhibitor (SSRI) for major depressive disorder (MDD). Sources of date were Medline/Pubmed, EMBASE, the Cochrane database, and program syllabi from major psychiatric meetings held since 1995. The study selection comprised double-blind, randomized clinical trials comparing T3-SSRI coinitiation therapy versus SSRI monotherapy for MDD. Data were extracted with the use of a precoded form. Data from four clinical trials involving a total of 444 patients with MDD were identified and combined using a random effects model. There was no statistically significant difference in terms of remission rates or response rates at week 1, week 2, or at endpoint between the two treatment groups (SSRI+T3 coinitiation therapy vs. SSRI monotherapy). Pooled response and remission rates at endpoint for the SSRI+T3 versus SSRI monotherapy groups were 64.6 versus 58.5% and 46.8 versus 44.8%, respectively. In addition, there was no statistically significant difference in overall rates of premature discontinuation of treatment, or in the rate of premature discontinuation of treatment owing to inefficacy or intolerance between the two treatment groups. Notwithstanding important methodological differences between the studies included in the meta-analysis in terms of patient characteristics and treatment protocols, these results do not support the notion that simultaneous initiation of treatment of MDD with an SSRI and T3 is more effective than SSRI monotherapy. However, given the etiologically diverse and clinically heterogeneous nature of MDD, it is at least plausible that T3-SSRIs coinitiation therapy may be effective for a particular subgroup of patients including patients with atypical depression or patients with a functional polymorphism of the D-1 deiodinase gene. Clearly, further work is needed to help determine whether there are specific MDD populations that can, indeed, benefit from T3-SSRI coinitiation therapy.

The Role of Cognitive-Behavioral Therapy and Fluoxetine in Prevention of Recurrence of Major Depressive Disorder

This study evaluated the role of cognitive-behavioral therapy (CBT) and fluoxetine in preventing recurrence of a depressive episode during maintenance phase treatment for patients with remitted major depressive disorder (MDD). Patients (n = 52) completed open acute fluoxetine treatment and sustained remission during a 28-week randomized continuation treatment (CBT + fluoxetine vs. fluoxetine only). They were assigned to one of four maintenance treatments: CBT + fluoxetine, CBT + placebo, fluoxetine only, and placebo only. There were no statistically significant differences in MDD recurrence between maintenance treatments, but continued antidepressant treatment (with or without CBT) provided an 18–21% lower MDD recurrence rate than placebo. These findings are consistent with those of recent antidepressant studies of chronic and recurrent MDD populations. Although sample sizes were small, CBT did not significantly lower rates of MDD recurrence.

Sleep is undisturbed in elderly, depressed individuals who have not sought health care

Sleep deficits are commonly found in geriatric depressed patients, particularly shortened rapid eye movements (REM) latency, disturbed sleep continuity, and decreased slow wave sleep (SWS). Here we report the sleep patterns of community volunteers responding to ads about memory loss and depression. The two groups, 24 geriatric-onset major depressive disorder (MDD) subjects with a minimal history of seeking treatment for depression and 24 gender- and age-matched control subjects, significantly differed from each other on only one measure of sleep-sleep latency; the MDD group showed a modest but significant shortening of latency to fall asleep. All other sleep/wake measures, including REM latency, temporal distribution of REM sleep across the night, SWS, and measures of nighttime wakefulness did not differ between groups. This lack of significant sleep disturbance suggests that the sleep deficits reported in many studies of major depression may be related to factors underlying treatment-seeking behaviors, physical health status, severity of the depression, or heterogeneity within the MDD population with some types seeking treatment and other not seeking it, rather than depressive state per se. The data indicate that community-dwelling healthy elderly individuals who have a diagnosed major depression but who have not actively sought health care do not necessarily manifest the sleep disturbances thought to be characteristic of major depressive illness.