How Effective Is Antidepressant Medication (ADM) Polypharmacy in Difficult to Treat Depression (DTD)? a Neuroblu Electronic Health Record (EHR) Report
Guruswamy G1, Valko M2, Rush AJ3, Kollins SH1
1Holmusk, New York, NY, USA, 2Holmusk, ARLINGTON, VA, USA, 3Curbstone Consultant LLC, Santa Fe, NM, USA
OBJECTIVES: To identify which DTD patients receive varying degrees of ADM polypharmacy; to assess outcomes of disease severity ([Clinical Global Impression Scale-Severity (CGI-S)] and daily function [Global Assessment of Function (GAF)] associated with each level of ADM polypharmacy; to compare those with meaningful gains and losses (+/-) of benefit over 6-months.
METHODS: A cohort study was conducted on adults with DTD who had an outpatient visit, CGI-S, and GAF recorded within +/-14 days of 3 measurement occasions (0, 3, & 6 mos.). Patient cohorts were defined by distinct ADMs (# 0-4+) prescribed during the 6-month observation period. Descriptive statistics and tests were done to describe and evaluate the relationships between baseline demographics, ADMs, and psychiatric comorbidities with outcomes. Outcomes were created by using linear regression and converting differences of CGI-S/GAF to +/-/no change ([CGI-S ≤-0.5, GAF≥5.0] / [CGI-S≥0.5, GAF≤-5.0] using the Holmusk NeuroBlu scalable data science platform-a 20-year, detailed, psychiatry-specific database of Electronic Health Records from multiple clinical sites across the U.S.
RESULTS: Altogether, 3,659 DTD patients (mean age= 43 yrs.; 27% male) received 0,1,2, 3, or 4+ ADMs (21%; 38%; 28%;10% & 3 % respectively). Baseline mean CGI-S and GAF were 4.2 and 5.5, respectively.GAD was the most prevalent (20%) comorbidity. 50% of the sample never had an ADM added after baseline Older, more severely ill, worse functioning patients were prescribed more ADMs. Neither CGI-S nor GAF mean scores significantly changed over time (-.12 and +1.7, respectively). The CGI-S and GAF groupings based on +/-/no change were unrelated to the number of ADMs prescribed, but these outcome groups based on each measure were significantly related to each other (<0.001).
CONCLUSIONS: Most DTD outpatients had little improvement in severity or function. More ADM prescriptions were not associated with better outcomes.
Conference/Value in Health Info
Clinical Outcomes, Epidemiology & Public Health
Comparative Effectiveness or Efficacy, Safety & Pharmacoepidemiology