Citation

Ouazana-Vedrines C, Lesuffleur T, Cuerq A, Fagot-Campagna A, Rachas A, Gastaldi-Ménager C, Hoertel N, Limosin F, Lemogne C, Tuppin P. Front. Psychiatry 2022; 13.

Copyright

(Copyright © 2022, Frontiers Media)

DOI

10.3389/fpsyt.2022.923916

PMID

unavailable

Abstract

BACKGROUND: Naturalistic studies regarding clinical outcomes associated with antidepressant treatment duration have yielded conflicting results, possibly because they did not consider the occurrence of treatment changes. This nation-wide population-based study examined the association between the number of filled prescriptions and treatment changes and long-term psychiatric outcomes after antidepressant treatment initiation.

METHODS: Based on the French national health insurance database, 842,175 adults who initiated an antidepressant treatment in 2011 were included. Cox proportional-hazard multi-adjusted regression models examined the association between the number of filled prescriptions and the occurrence of treatment changes 12 months after initiation and four outcomes during a 5-year follow-up: psychiatric hospitalizations, suicide attempts, sick leaves for a psychiatric diagnosis, new episodes of antidepressant treatment.

RESULTS: During a mean follow-up of 4.5 years, the incidence rates of the four above-mentioned outcomes were 13.49, 2.47, 4.57, and 92.76 per 1,000 person-years, respectively. The number of filled prescriptions was associated with each outcome (adjusted HRs [95% CI] for one additional prescription ranging from 1.01 [1.00-1.02] to 1.10 [1.09-1.11]), as was the occurrence of at least one treatment change vs. none (adjusted HRs [95% CI] ranging from 1.18 [1.16-1.21] to 1.57 [1.79-1.65]). Furthermore, the adjusted HRs [95% CI] of the number of filled prescriptions were greater in patients with (vs. without) a treatment change for psychiatric hospitalizations (1.12 [1.11-1.14] vs. 1.09 [1.08-1.10], p for interaction = 0.002) and suicide attempts (1.12 [1.09-1.15] vs. 1.06 [1.04-1.08], p for interaction = 0.006). Limitations: Lack of clinical data about the disorders warranting the prescriptions or their severity.

CONCLUSION: Considering treatment changes is critical when using administrative claims database to examine the long-term psychiatric outcomes of antidepressant treatments in real-life settings. Copyright © 2022 Ouazana-Vedrines, Lesuffleur, Cuerq, Fagot-Campagna, Rachas, Gastaldi-Ménager, Hoertel, Limosin, Lemogne and Tuppin.

Language: en

Keywords

adult; human; age; gender; suicide; female; male; incidence; suicide attempt; hospitalization; treatment outcome; disease severity; social isolation; major clinical study; prescription; antidepressant agent; neuroleptic agent; middle aged; benzodiazepine derivative; follow up; atypical antipsychotic agent; ICD-10; medical leave; mood stabilizer; Article; treatment duration; national health insurance; cohort studies; administrative claims database; antidepressive agents; sick leaves