Treatment patterns for patients with treatment resistant depression in France using nationwide claims database

BackgroundPrevalence of Treatment-Resistant Depression (TRD) varied widely across studies due to heterogeneous definitions. Several treatment strategies exist to manage patients with TRD but evidence from real-world data is scarce. Investigating their use in real-life settings is important to understand national prescribing practices and to refine prevalence estimation. MethodAll adult patients ([≥] 18 years) with a TRD episode for the year 2019 were identified in a sample of four French regions accounting for 27% of national individuals. After exclusion of patients with psychotic or bipolar disorders, Parkinsons disease, and dementia, TRD was defined by i/ 3 successive sequences of different antidepressants (AD), or ii/ the dispensing of several different AD together, or iii/ an AD with a potentiator (lithium, antiepileptic drugs, or antipsychotic drugs) over the same treatment period. The prevalence rate was estimated for the year 2019 and treatment patterns were described by treatment class and molecule. ResultsFor the year 2019, 66,810 patients were identified with TRD, accounting for 23.9% of all patients treated for depression. The mean age was 56 years ({+/-}15.9) with 63.7% of women. Standardized prevalence of TRD was estimated at 35.1 per 10 000 patients, and 25.8 per 10,000 patients when excluding patients probably treated for another primary diagnosis than depression. Association of an AD with an antipsychotic was the most frequently used strategy, with SSRIs and second-generation antipsychotics being the most often prescribed. ConclusionThis study provides robust population-based estimates of the prevalence of TRD in the French population. Description of treatment patterns highlight the widespread use of second-generation antipsychotics as potentiator of antidepressants.