Treatment Guidelines Not Followed in Many Major Depressive Disorder Cases

doctor talking to woman and writing
doctor talking to woman and writing
Researchers found that patients with major depressive disorder would have greater outcomes taking a multidisciplinary approach by including primary care physicians, specialists, nurses and administrators with a dollar amount of savings in the billions projected over 15 years.

Although antidepressant adherence has increased in recent years, 54.7% of patients diagnosed with depressive disorder are not receiving antidepressants or psychotherapy after the first 5 months following their initial diagnosis of major depressive disorder, according to a study published in Psychiatric Services.

In this retrospective study, researchers analyzed claims information from the IBM MarketScan Commercial Claims and Encounters database to gather data on individuals with a depressive disorder diagnosis in their medical claim between 2008 and 2015 (N=24,579). Pharmacological treatments were noted, and IBM’s Red Book was used to assess patients’ antidepressant strength and class.

Researchers used the practice guidelines recommended by the American Psychiatric Association (APA) to evaluate starting dosages of the first filled antidepressant. Antidepressant treatment adherence in the acute or continuation phase was defined as 84 of 114 days or 180 of 231 days, respectively, of continuous use from the first prescription date. The proportion of days covered was chosen to calculate the National Committee for Quality Assurance’s (NCQA’s) Healthcare Effectiveness Data and Information Set (HEDIS) adherence metrics.

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The major finding of this study was that despite the APA’s recommendation that antidepressants remain an integral part of treatment for this population, 43.8% of patients with severe major depressive disorder used psychotherapy alone as their initial treatment. Of the individuals who were prescribed antidepressants, 34.5% had starting dosages outside the APA guideline-recommended dosage, more of which were below the recommendation (23.1%) than above (11.4%). Just 41.7% and 32% of individuals who were treated with an antidepressant and had sufficient follow-up time were adherent in the acute and continuation phases, respectively.

Depression severity was negatively associated with antidepressant adherence, but positively associated with psychotherapy use. Immediate treatment after diagnosis of major depressive disorder and lowering out-of-pocket expenses was associated with antidepressant adherence and intensive psychotherapy utilization.

This study was limited by its use of retrospective medical claims data.

The researchers concluded that their study identified multiple areas of health care use that may be addressed to facilitate treatment adherence and improve outcomes among patients with major depressive disorder.


Gaspar FW, Zaidel CS, Dewa CS. Rates and determinants of use of pharmacotherapy and psychotherapy by patients with major depressive disorder [published online January 11,2019]. Psychiatr Serv. doi: 10.1176/