A retrospective examination of care pathways in individuals with treatment-resistant depression

TY - JOUR

T1 - A retrospective examination of care pathways in individuals with treatment-resistant depression

AU - Day, Elana

AU - Shah, Rupal

AU - Taylor, Rachael

AU - Marwood, Lindsey

AU - Young, Allan

AU - Cleare, Anthony

AU - Strawbridge, Becci

N1 - Funding Information: This project is funded through the National Institute for Health Research (NIHR) Health Technology Assessment programme (reference 14/222/02). This paper represents independent research part-funded by the NIHR Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, and by the NIHR Oxford Health BRC and NIHR Oxford Cognitive Health Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funding sources had no role in the study design; collection, analysis and interpretation of data; writing of the report or decision to submit the article for publication. Funding Information: R.Strawbridge., L.M., A.H.Y. and A.J.C. conceptualised the study. E.D., R.Shah, R.W.T., K.N. and J.H. handled data acquisition. E.D. and R.Shah conducted formal analysis. E.D., R.Shah, R.W.T., A.J.C. and R.Strawbridge interpreted the analysis. A.J.C., J.R.G. and R.H.M.-W. were responsible for funding acquisition. R.H.M.-W., J.R.G., A.B., A.H.Y., A.J.C., L.M. and R.W.T. were responsible for the study investigation/methodology. R.Strawbridge and A.J.C. supervised the study. E.D. and R.Shah wrote the original draft of the manuscript. All authors reviewed and edited the manuscript, and gave final approval for publication. Publisher Copyright: Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/5/14

Y1 - 2021/5/14

N2 - Background Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear. Aims To explore the extent and nature of ‘treatment gaps’ (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK. Method Five treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced. Results Of 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment. Conclusions There appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.

AB - Background Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear. Aims To explore the extent and nature of ‘treatment gaps’ (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK. Method Five treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced. Results Of 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment. Conclusions There appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.

UR - http://www.scopus.com/inward/record.url?scp=85107654471&partnerID=8YFLogxK

U2 - 10.1192/bjo.2021.59

DO - 10.1192/bjo.2021.59

M3 - Article

SN - 2056-4724

VL - 7

SP - 1

EP - 11

JO - British Journal of Psychiatry Open

JF - British Journal of Psychiatry Open

IS - 3

M1 - e101

ER -