Despite several national DCGs, suboptimal treatment with antidepressants (ADs) still occurs. In an article in BMC Psychiatry, researchers conducted an 8-week observational, prospective cohort study to investigate the DCG concordance and outcomes of depression treatments in psychiatric settings.
The authors wrote, “In this observational eight-week follow-up study, we aimed to examine Finnish DCG adherence in the psychiatric care settings of Helsinki University Hospital, Finland’s largest hospital district. Specifically, we aimed to describe (1) the clinical characteristics, prior course of illness, and treatment history of patients currently referred to psychiatric care, (2) the treatment received, focusing on AD use, and (3) the short-term treatment outcome. We expected treatment practice to align with the current recommendations, including appropriate AD dosage, treatment duration, and follow-up.”
At baseline, 2 weeks, and 8 weeks, using interviews and questionnaires, the researchers assessed the treatment received and outcomes of 128 psychiatric outpatients and inpatients participating in the Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders study.
Inclusion criteria were an ICD-10 diagnosis of a depressive disorder, a Patient Health Questionnaire-9 symptom (PHQ-9) score ≥10, and a new antidepressant prescribed. The primary outcome of the study was within-individual change in PHQ-9 scores.
Results revealed that at baseline, patients had predominately recurrent (83%) and in 19% treatment-resistant depression (TRD), and the average preceding duration of the current episode was 6.5 months. Results also revealed that at 8 weeks, 85% of the patients (n = 107) were prescribed a DCG-concordant antidepressant dose; however, due to the lack of antidepressant combinations and augmentations, fewer TRD than non-TRD patients (25% vs. 84%, P <0.005) received sufficient antidepressant treatment.
Additionally, 33.3% of the patients received inadequate follow-up, and overall, only 53% received treatment compatible with DCG recommendations for adequate pharmacotherapy and follow-up. Moreover, the average decline in PHQ-9 scores (-3.8 ± SD 5.7) was significant (P <0.0005). Predicted by a lower baseline PHQ-9 score, recurrent depression, and female gender, an estimated 40% of the patients attained a subthreshold level of depression (PHQ-9 <10); however, 45% experienced no noteworthy clinical improvement (PHQ-9 score decrease <20%).
Based on their findings, the authors concluded, “Our results suggest that inadequate treatment of depression continues to occur in psychiatric care settings. Observed treatment outcomes were modest, and only 10% of patients reached remission. AD treatment was lacking particularly for TRD patients, as only 25% received DCG-recommended AD combinations or pharmacological augmentation. The intensity of treatment monitoring was inadequate for one-third of all patients.”
Lastly, the authors noted that their findings regarding suboptimal treatment warrant greater focus since the health and economic burdens associated with depressive disorders continue to mount. Based on their findings, the researchers emphasized the significance of structured data collection and usage of measurement-based care to ensure the quality of all treatment for depression.
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