Measure description
Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.
- Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).
- Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).
Rationale
In 2017, over 17 million adults in the United States had at least one major depressive episode in the past 12 months (SAMHSA, 2018), and depression is estimated to affect nearly a quarter of adults in their lifetime (Burcusa & Iacono, 2007). Depression is associated with other chronic diseases, as it adversely affects the course, complications and management of other chronic medical illnesses such as diabetes, cancer, cardiovascular disease and asthma (Katon & Guico-Pabia, 2011).
Symptoms of depression include appetite and sleep disturbances, anxiety, irritability and decreased concentration (Charbonneau et al., 2005). The American Psychiatric Association recommends use of antidepressant medication and behavioral therapies, such as psychotherapy, to treat depression (American Psychiatric Association, 2010).
For the past 50 years, antidepressant medication has proven to be effective especially for patients with more severe symptoms (Fournier et al., 2010). Among patients who initiate antidepressant treatment, one in three discontinues treatment within one month, before the effect of medication can be assessed, and nearly one in two discontinues treatment within three months (Simon, 2002).
Clinical guidelines for depression emphasize the importance of effective clinical management in increasing patients’ medication compliance, monitoring treatment effectiveness, and identifying and managing side effects. If pharmacological treatment is initiated, appropriate dosing and continuation of therapy through the acute and continuation phases decrease recurrence of depression. Thus, evaluation of duration of pharmacological treatment serves as an important indicator in promoting patient compliance with the establishment and maintenance of an effective medication regimen.
Clinical Recommendation Statement
American Psychiatric Association (2010):
- “An antidepressant medication is recommended as an initial treatment choice for patients with mild to moderate major depressive disorder [I: Recommended with substantial clinical confidence] and definitely should be provided for those with severe major depressive disorder unless electroconvulsive therapy (ECT) is planned [I: Recommended with substantial clinical confidence].”
- Patients should be given a realistic notion of what can be expected during the different phases of treatment, including the likely time course of symptom response and the importance of adherence for successful treatment and prophylaxis [I].
- During the acute phase of treatment, patients should be carefully and systematically monitored on a regular basis to assess their response to pharmacotherapy, identify the emergence of side effects (e.g., gastrointestinal symptoms, sedation, insomnia, activation, changes in weight, and cardiovascular, neurological, anticholinergic, or sexual side effects), and assess patient safety [I].
- “During the continuation phase of treatment, the patient should be carefully monitored for signs of possible relapse [I: Recommended with substantial clinical confidence]. Systematic assessment of symptoms, side effects, adherence, and functional status is essential [I: Recommended with substantial clinical confidence], and may be facilitated through the use of clinician- and/or patient-administered rating scales [II: Recommended with moderate clinical confidence]. To reduce the risk of relapse, patients who have been treated successfully with antidepressant medications in the acute phase should continue treatment with these agents for 4–9 months [I: Recommended with substantial clinical confidence].”
Department of Veterans Affairs, and Health Affairs, Department of Defense (2016):
- ”In patients at high risk for recurrent depressive episodes and who are treated with pharmacotherapy, we recommend offering maintenance pharmacotherapy for at least 12 months and possibly indefinitely.” [Strong For]
- “After initiation of therapy or a change in treatment, we recommend monitoring patients at least monthly until the patient achieves remission. At minimum, assessments should include a measure of symptoms, adherence to medication and psychotherapy, and emergence of adverse effects.” [Strong For]
- “In patients with MDD who achieve remission with antidepressant medication, we recommend continuation of antidepressants at the therapeutic dose for at least six months to decrease risk of relapse” [Strong For]