Outcomes associated with antidepressant treatment according to the number of prescriptions and treatment changes: 5-year follow-up of a nation-wide cohort study

Charles Ouazana-Vedrines; Thomas Lesuffleur; Anne Cuerq; Anne Fagot-Campagna; Antoine Rachas; Chrystelle Gastaldi-Ménager; Nicolas Hoertel; Frédéric Limosin; Cédric Lemogne; Philippe Tuppin

doi:10.3389/fpsyt.2022.923916

Outcomes associated with antidepressant treatment according to the number of prescriptions and treatment changes: 5-year follow-up of a nation-wide cohort study

Front Psychiatry. 2022 Sep 8:13:923916. doi: 10.3389/fpsyt.2022.923916. eCollection 2022.

Authors

Affiliations

¹ UFR de Médecine, Faculté de Santé, Université Paris Cité, Paris, France.
² Service de Psychiatrie de l'Adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France.
³ Department of Pathologies and Patients, Caisse Nationale d'Assurance Maladie, Paris, France.
⁴ INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, Université Paris Cité, Paris, France.
⁵ Service de Psychiatrie et d'Addictologie de l'Adulte et du Sujet Âgé, AP-HP, Hôpital Corentin-Celton, Issy-les-Moulineaux, France.

Abstract

Background: Naturalistic studies regarding clinical outcomes associated with antidepressant treatment duration have yielded conflicting results, possibly because they did not consider the occurrence of treatment changes. This nation-wide population-based study examined the association between the number of filled prescriptions and treatment changes and long-term psychiatric outcomes after antidepressant treatment initiation.

Methods: Based on the French national health insurance database, 842,175 adults who initiated an antidepressant treatment in 2011 were included. Cox proportional-hazard multi-adjusted regression models examined the association between the number of filled prescriptions and the occurrence of treatment changes 12 months after initiation and four outcomes during a 5-year follow-up: psychiatric hospitalizations, suicide attempts, sick leaves for a psychiatric diagnosis, new episodes of antidepressant treatment.

Results: During a mean follow-up of 4.5 years, the incidence rates of the four above-mentioned outcomes were 13.49, 2.47, 4.57, and 92.76 per 1,000 person-years, respectively. The number of filled prescriptions was associated with each outcome (adjusted HRs [95% CI] for one additional prescription ranging from 1.01 [1.00-1.02] to 1.10 [1.09-1.11]), as was the occurrence of at least one treatment change vs. none (adjusted HRs [95% CI] ranging from 1.18 [1.16-1.21] to 1.57 [1.79-1.65]). Furthermore, the adjusted HRs [95% CI] of the number of filled prescriptions were greater in patients with (vs. without) a treatment change for psychiatric hospitalizations (1.12 [1.11-1.14] vs. 1.09 [1.08-1.10], p for interaction = 0.002) and suicide attempts (1.12 [1.09-1.15] vs. 1.06 [1.04-1.08], p for interaction = 0.006).

Limitations: Lack of clinical data about the disorders warranting the prescriptions or their severity.

Conclusion: Considering treatment changes is critical when using administrative claims database to examine the long-term psychiatric outcomes of antidepressant treatments in real-life settings.

Keywords: administrative claims database; antidepressive agents; cohort studies; sick leaves; suicide.