Introduction: Treatment Resistant Depression (TRD) is a significant health concern. This study characterizes TRD and non-TRD patients and episodes including episode duration and treatment patterns in a large cohort of major depressive disorder (MDD) patients from a US claims database. Methods: Patients between 18 and 64 years with a new diagnosis of MDD and without a previous or comorbid diagnosis of schizophrenia or bipolar disease were included in this study. These patients were followed forward longitudinally and those who failed two regimens involving antidepressants and antipsychotics were classified as having TRD. TRD episodes and patients were characterized and compared to non-TRD counterparts. Results: Of the 40,350 new patients with MDD, 7.7% (N=3,095) met the criteria for TRD. The median time to an episode becoming TRD was approximately 1 year. The mean duration of TRD episode was 1004 days (vs. 452 days for a non-TRD episode). About half of TRD episodes had four or more lines of therapy; half of the treatment regimens include a combination of drugs. Patients, on average had 16 psychotherapy sessions per TRD episode compared to 4 psychotherapy sessions per non-TRD episode. Average hospitalization costs were higher for TRD than non-TRD episodes: $6,464 vs. $1,734 as were all other health care utilization costs. Discussion and Conclusion: Though this study was limited to relatively young and commercially covered patients and used a very rigorous definition of TRD, the results highlight high unmet medical need and burden of TRD on health care resources.
Nicole Cossrow, PhD, MPH; Ravi Chand, PGDM; Maneesha Mehra, MSc, MPH; Nicole Kubitz, MD
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