Determinants of antidepressant treatment outcome

Objective: To understand the determinants of the outcome of an episode of m ajor depression, including factors that affect receipt of guideline-consist ent care and their subsequent effect on treatment outcomes, particularly re lapse or recurrence. Results of previous studies are generalized to a popul ation typical of depressed individuals in the United States, ie, a cohort o f antidepressant users with employer-provided health benefits. Study Design: A quasi-experimental design was used to assess the determinan ts of the outcome of an episode of major depression. Healthcare utilization -based measures of treatment characteristics and outcomes were used. Patients and Methods: The final analytical file for this study contained da ta on 2917 patients who had Bn antidepressant prescription associated with an indicator of a depressive disorder. We identified relapse or recurrence of depression by (1) a new episode of antidepressant therapy, (2) suicide a ttempt, (3) psychiatric hospitalization, (4) mental health-related emergenc y department visits, or (5) electroconvulsive therapy. Antidepressant use p atterns were used to construct a measure for adherence to treatment guideli nes. Multivariate Cox proportional hazard and logit regression models were used to predict relapse/recurrence and adherence with treatment guidelines, respectively, For each patient, Results: Factors that affect relapse/recurrence include comorbidities, demo graphics, and adherence to treatment guidelines. Factors that affect adhere nce to treatment guidelines include choice of initial antidepressant drug, comorbidities, psychotherapy, and frequency of physician visits. Conclusions: Adherence to treatment guidelines was associated with a signif icant reduction in the likelihood of relapse or recurrence of depression. C hoice of initial antidepressant drug affects adherence to treatment guideli nes.