Investigation of the pharmacological treatment patterns of Chinese patients with major depressive disorder under real-world settings using multi-channel sequence analysis

BACKGROUND: Despite many treatment guidelines available now, the treatment patterns of major depressive disorder (MDD) in China haven't been well-understood due to complexity and diversity. AIM: To describe pharmacological treatment patterns of MDD patients in real-world settings using electronic health records from a major psychiatric hospital in China. METHODS: MDD patients (18–65 years, ICD-10: F32.x, F33.x) newly initiated single antidepressant (AD) in 2015 were enrolled, the date of first AD prescription during the study period was defined as index date, and eligible patients were followed up to 1 year. Treatment patterns were revealed and analyzed using multi-channel sequence analysis (MCSA), considering patients' chronological sequences (in days) of AD prescription, cumulative treatment step(s), and polypharmacy usage during the follow-up. RESULTS: This study (n = 5,003) identified four types of MDD treatment patterns. The first type (1-time treatment) represents the largest proportion of patients (73.6%, n = 3,686), followed by the second type (6-month consistent treatment) and third type (long-term, consistent treatment) collectively accounted for 20.6% (n = 1,031) of patients, by contrast the last type (long-term, inconsistent treatment) made up the rest 5.7% (n = 286) of patients while exhibiting the most complicated treatments patterns. The choice of AD was dominated by selective serotonin reuptake inhibitors (SSRIs), while treatment duration spent in polypharmacy spanned at 2.8%, 16.4%, 2.0%, and 36.5% over the four types, respectively. CONCLUSION: Treatment patterns reflecting real-world pharmacological treatment practices of MDD in China were revealed using MCSA. The observed discrepancies between real-world practice and treatment guidelines provided additional insights in improving the clinical management of MDD.