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Treatment Selection for Major Depressive Disorder in Veterans Health Administration Outpatients
Mihaela Aslan1,2, Daniel S Tylee1,3, Peijun Chen4,5
1VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven.
JAMA Network Open
|August 13, 2026
Summary
Treatment for major depressive disorder (MDD) in veterans shows declining psychotherapy and antidepressant use, with a concerning rise in undertreatment. Further investigation is needed to understand these trends and ensure adequate mental health care access.
Area of Science:
- Mental Health Research
- Clinical Psychiatry
- Health Services Research
Background:
- Major depressive disorder (MDD) treatment selection is crucial for effective care within large health systems.
- Evaluating adherence to treatment guidelines and identifying trends is essential for improving clinical practice.
Purpose of the Study:
- To characterize treatment selection patterns for major depressive disorder (MDD) among veterans receiving outpatient care.
- To analyze trends in psychotherapy, medication, and combination therapy use between fiscal years 2011 and 2025 within the Veterans Health Administration (VHA).
Main Methods:
- Retrospective cohort study utilizing VHA health records of veterans diagnosed with MDD.
- Analysis of outpatient procedure codes and prescription records to determine annual treatment proportions.
- Exclusion of individuals younger than 18 or older than 109, and those with bipolar or schizophrenia spectrum disorders.
Main Results:
- Over 1.5 million veterans received outpatient MDD treatment between FY11 and FY25.
- Decreasing trends observed in psychotherapy, antidepressant, and combination therapy use.
- Increasing proportions of veterans received psychotherapy without antidepressants, antidepressants without psychotherapy, or neither, with a notable rise in undertreatment (up to 10.2% by FY25).
- Shifts in medication use included decreased selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, and increased serotonin-norepinephrine reuptake inhibitors (SNRIs).
Conclusions:
- While most veterans received recommended MDD treatment, a significant increasing trend in undertreatment was observed.
- Findings highlight the need to investigate potential undertreatment within VHA outpatient services.
- Further examination of mental health service availability and factors influencing treatment decisions is warranted.
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