Background:
Many patients discontinue antidepressant therapy long before the 6-month
minimum duration recommended for the treatment of major depression and
many other diagnoses. We explore various possibilities, including
prescriber intent and patient diagnosis, to explain some of this early
discontinuation.
Method: Patients from a single health maintenance organization who filled at
least 1 prescription for an antidepressant during the first 4 months of
2001 and who did not fill an antidepressant prescription in the 6 months
prior were identified retrospectively. Prescribers of those patients'
antidepressants were surveyed for patient diagnosis and length of
intended treatment with antidepressant medication. Actual length of
treatment was then obtained from pharmacy data and correlated with
survey data and other variables.
Results: Prescriber surveys were returned for 51% (485/951) of the patients
identified. Surveys indicated that for 34% of initial antidepressant
prescriptions, < 6 months of treatment was intended. Important
determinants of the length of antidepressant therapy included prescriber
specialty area, number of prescribers, prescriber intent, diagnosis,
specific antidepressant used, and concomitant benzodiazepine use.
Conclusions: Prescriber intention to treat many patients with short courses of
antidepressants, often for off-label, non-mental health indications, was
correlated with early discontinuation and needs further study of both
its rationale and efficacy. Although less prevalent, short-term
treatment of mental health disorders, including depression, was also
intended by psychiatrists and other prescribers. The widespread practice
of intended short-term treatment with antidepressants needs to be
understood better, since it results in guideline-incompatible, early
antidepressant discontinuation.
(J
Clin Psychiatry 2004;65:395-404)
Received July 7,
2003; accepted Aug. 12, 2003. From Health New England, Springfield,
Mass. (Drs. Pomerantz, Boss, and Ebert and Messrs. Walker and Alber);
Sloan School of Management (Drs. Finkelstein
and Berndt) and Department of Economics (Ms. Kadiyam), Massachusetts
Institute of Technology, Cambridge; Pharmacia Corporation, New York,
N.Y. (Ms. Poret); Department of Economics, Columbia University, New
York, N.Y. (Dr. Das); and Harvard Medical School, Cambridge, Mass. (Dr.
Pomerantz).
This research was
funded by an unrestricted grant to Health New England from Pharmacia
Corporation, New York, N.Y. Dr. Pomerantz has
been a consultant for Lilly and Forest; has received honoraria from
Pfizer, GlaxoSmithKline, and Lilly; and has been on the
speakers/advisory board for Lilly. Dr. Finkelstein has been a consultant
for Pfizer, Merck, Wyeth, and Medstat Group and has received
grant/research support from Pfizer, Merck, Wyeth, and Lilly. Ms. Poret
is an employee of Pharmacia. Acknowledgments
appear at the end of the article. Corresponding
author and reprints: Jay M. Pomerantz, M.D., 123 Dwight Rd., Longmeadow,
MA 01106 (e-mail: jayp@map.com).
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