Real-World Antidepressant Treatment Persistence in Children and Adolescents with Major Depressive Disorder in Japan:...

Real-world evidence on major depressive disorder (MDD) management in children and adolescents is limited in Japan. This study aimed to evaluate the antidepressant treatment persistence rate in this population.

This study evaluated the antidepressant treatment persistence in children and adolescents (aged 6-18 years) with MDD who had claims data from 6 months before to 1 year after the index date between 2012 and 2017 using a large-scale Japanese claims database. Treatment persistence was defined as the absence of a prescription gap beyond 30 days. Factors associated with it were examined using a Cox proportional hazards model (JMP ver.18).

In total, 1,582 patients on the index date were included. The treatment persistence rate for any antidepressant was 62.6% on the 30th postindex day, 46.1% on the 60th postindex day, 22.3% on the 180th postindex day, and 10.2% on the 365th postindex day. The most frequently prescribed initial antidepressant was sulpiride (30.0%). By drug class, selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed (39.9%), followed by tricyclic or tetracyclic antidepressants (TCAs) (18.3%) and serotonin and norepinephrine reuptake inhibitors (SNRIs) (6.3%). The significant factors associated with treatment discontinuation with any antidepressant were treatment initiation with sulpiride, noradrenergic and specific serotonergic antidepressants, serotonin antagonist and reuptake inhibitors, or TCAs, as well as consultations with nonmental health specialists.

Antidepressant treatment persistence rates in children and adolescents with MDD were low. However, the rate varied depending on the first prescribed antidepressant and mental health specialist involvement. Relatively high persistence was observed among those prescribed SSRIs or SNRIs as their initial antidepressant treatment and those who received clinical interventions provided by mental health specialists. Given the claims data and no clinical severity measures, these findings should be interpreted with caution.