Subgrouping time-dependent prescribing patterns of first-onset major depressive episodes by psychotropics dissection

Hsi-Chung Chen; Hui-Hsuan Hsu; Mong-Liang Lu; Ming-Chyi Huang; Chun-Hsin Chen; Tzu-Hua Wu; Wei-Chung Mao; Chuhsing K Hsiao; Po-Hsiu Kuo

doi:10.5498/wjp.v11.i11.1116

Subgrouping time-dependent prescribing patterns of first-onset major depressive episodes by psychotropics dissection

World J Psychiatry. 2021 Nov 19;11(11):1116-1128. doi: 10.5498/wjp.v11.i11.1116.

Authors

Hsi-Chung Chen¹, Hui-Hsuan Hsu², Mong-Liang Lu³, Ming-Chyi Huang⁴, Chun-Hsin Chen³, Tzu-Hua Wu⁵, Wei-Chung Mao⁶, Chuhsing K Hsiao⁷, Po-Hsiu Kuo⁸

Affiliations

¹ Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei 100, Taiwan.
² Center of Statistical Consultation and Research, National Taiwan University Hospital, Taipei 100, Taiwan.
³ Department of Psychiatry, Wan-Fang Hospital & School of Medicine, College of Medicine, Taipei Medical University, Taipei 100, Taiwan.
⁴ Department of Psychiatry, Taipei City Hospital, Songde Branch, Taipei 100, Taiwan.
⁵ Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University,Taipei 110, Taiwan.
⁶ Department of Psychiatry, Cheng-Hsin General Hospital, Taipei 100, Taiwan.
⁷ Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan.
⁸ Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan. phkuo@ntu.edu.tw.

Abstract

Background: Subgrouping patients with major depressive disorder is a promising solution for the issue of heterogeneity. However, the link between available subtypes and distinct pathological mechanisms is weak and yields disappointing results in clinical application.

Aim: To develop a novel approach for classification of patients with time-dependent prescription patterns at first onset in real-world settings.

Methods: Drug-naive patients experiencing their first major depressive episode (n = 105) participated in this study. Psychotropic agents prescribed in the first 24 mo following disease onset were recorded monthly and categorized as antidepressants, augmentation agents, and hypnosedatives. Monthly cumulative doses of agents in each category were converted into relevant equivalents. Four parameters were used to summarize the time-dependent prescription patterns for each psychotropic load: Stability, amount, frequency, and the time trend of monthly prescriptions. A K-means cluster analysis was used to derive subgroups of participants based on these input parameters of psychotropic agents across 24 mo. Clinical validity of the resulting data-driven clusters was compared using relevant severity indicators.

Results: Four distinct clusters were derived from K-means analysis, which matches experts' consent: "Short-term antidepressants use", "long-term antidepressants use", "long-term antidepressants and sedatives use", and "long-term antidepressants, sedatives, and augmentation use". At the first 2 years of disease course, the four clusters differed on the number of antidepressants used at adequate dosage and duration, frequency of outpatient service use, and number of psychiatric admissions. After the first 2 years following disease onset, depression severity was differed in the four subgroups.

Conclusion: Our findings suggested a new approach to optimize the subgrouping of patients with major depressive disorder, which may assist future etiological and treatment response studies.

Keywords: Classification; Depression; Depression treatment; First episode; Psychopharmacology.