DSRM Treatment Regimen Could Benefit Patients with Major Depressive Disorder

While major depressive disorder (MDD) has a lifetime prevalence of more than 20% in the United States, treatment guidelines and options are often underutilized properly for patients.

Rakesh Jain, MD, MPH

According to new findings, standard oral antidepressants may take weeks of continued treatment to achieve a clinical response and patients are often unresponsive to the treatment.

Investigators, led by Rakesh Jain, MD, MPH of the Texas Tech School of Medicine, found that few patients with MDD are treated with a dopamine-serotonin receptor modulator (DSRM, also known as atypical antipsychotic) in their treatment regimen, despite its potential effectiveness.

These findings were presented at the 2021 American Psychiatric Association Annual Meeting.

The team’s main objective was to characterize adjunctive treatment patterns of patients with MDD.

Study

Investigators included adults with newly diagnosed MDD and ≥1 major depressive episode (MDE), defined as ≥1 medical claim and ≥1 antidepressant claim within 60 days of diagnosis.

The data was collected from 2009 – 2017 through the IBM MarketScan Commercial Claims and Encounters Database. Patients were required to have ≥12 months of continuous insurance enrollment before and after diagnosis.

Investigators defined lines of therapy (LOTs) as the period of continuous treatment with consistent antidepressants, DSRMs, and mood stabilizers within an MDE.

Patients first LOT was required to be an antidepressant monotherapy.

A LOT would end with a treatment change of discontinuation (>30 days without medication), switch to different antidepressant, addition of adjunctive therapy (antidepressant combination, DSRM-adjunctive, mood-stabilizer adjunctive), or de-escalation of adjunctive therapy.

Results

The study included a total of 455,082 with MDD, with 40,315 (9%) patients receiving adjunctive therapy. In patients who received adjunctive therapy, 8,024 (20%) received DSRM adjunctive regimens, or 2% of all patients.

Most regimens were monotherapy treatments, which decreased with subsequent LOTs and adjunctive treatments increased with subsequent LOTs.

Investigators identified 1860 different adjunctive regimens, with 68% of patients having at least one of the 30 most common regimens. In this group, 90% were on antidepressant combination and 10% were on DSRM-adjunctive treatment.

The team noted that DSRM adjunctive regimen remained under 5% across multiple LOTs in each MDE in all treatment regimens. In patients with adjunctive therapy, 20% included treatment with a DSRM-adjunctive.

The top DSRM used were aripiprazole (44%), quetiapine (33%), and risperidone (10%).

Investigators found on average, patients who received an adjunctive DSRM had it occur on their 3rd LOT and over a year (mean, 393.3 days) from initial antidepressant treatment.

The team noted that patients treated with DSRM discontinued treatment less frequently versus monotherapy, as well as fewer treatment de-escalations.

Conclusion

Investigators concluded that the lack of patients treated with DSRM demonstrated a possible improvement in future treatment options.

“These results suggest a lack of adherence to treatment guidelines with underutilization of potentially effective treatments, illustrating an opportunity to improve therapy regimens for patients with MDD,” investigators wrote.

The study, “Adjunctive Treatment Patterns Among Patients With Major Depressive Disorder,” was published online by the American Psychiatric Association