Real-world treatment patterns and persistent symptoms in adults with depression undergoing antidepressant treatment.

BACKGROUND: Despite availability of antidepressant treatments (ADTs), many patients with depression do not achieve remission, requiring additional lines of therapy (LOTs). This retrospective observational study evaluated treatment patterns and persistent symptoms in adults with depression receiving ADT. METHODS: De-identified health insurance claims and electronic health records of adults (≥18 years) diagnosed with depression were analyzed from the HealthVerity database. Patients with psychosis or depression before index diagnosis were excluded. Primary outcomes included treatment patterns in up to 4 LOTs by ADT class among patients receiving ≥1 ADT prescription and persistent symptoms (within 3 categories: sleep disturbances, cognitive impairment, sexual dysfunction) in patients receiving ADT monotherapy. Results were analyzed using descriptive statistics; persistent symptom counts were annualized as total symptoms per patient divided by duration of follow-up in years. RESULTS: Of 6,315,125 eligible patients, 2,822,874 (44.7%) received ADT. Nearly half (47.4%) received >1 LOT. ADT monotherapy represented 91.6% of regimens in LOT1, declining to 57.1% in LOT4. Selective serotonin reuptake inhibitors were the most prescribed ADTs. Of those receiving ADT, 97.5% (n = 2,752,508) received monotherapy and were assessed for persistent symptoms; 445,399 (16.2%) experienced ≥1 persistent symptom. Mean annualized persistent symptom count was 3.9 per patient (median 1.7 [IQR 0.8-3.7]). Sleep disturbances were most common (82.0%), followed by cognitive impairment (14.1%) and sexual dysfunction (9.2%). CONCLUSION: Real-world data indicate that more than half of patients with depression had no observed ADT. Depression symptoms persist in some patients despite ADT, highlighting the need for individualized strategies and adherence to clinical guidelines.