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Psychotropic Prescription Patterns Among Patients Diagnosed With Depressive Disorder Based on Claims Database in Japan

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Abstract

Background and Objective

Clinical guidelines recommend monotherapy with antidepressants for the treatment of major depression. This study examined prescription patterns with regard to both duration and type of treatment used among patients with newly diagnosed non-psychotic major depression based on a claims database from health insurance societies between 2008 and 2011 in Japan.

Methods

A retrospective cohort (N = 600,000) followed up for 4 years was used to identify patients (age ≥18 years) with newly diagnosed non-psychotic major depression. The prescription patterns and polypharmacy were examined. Four different types of pharmaceutical drugs were defined as possible psychotropic agents for major depression: (1) first- and/or second-generation antidepressants; (2) benzodiazepines; (3) sulpiride; and (4) antipsychotics. The data were analyzed by an intent-to-treat approach at months 0, 1, 3, 6, and 12 from the date of diagnosis.

Results

A total of 7,338 patients (3,684 males and 3,654 females, mean age 36.8 ± 10.9 years) with newly diagnosed non-psychotic major depression were identified. The median duration of treatment was 122 days. The proportion of patients in the cohort prescribed at least one type of defined psychotropic agents was 75.6 % (month 0), 47.3 % (month 1), 36.0 % (month 3), 26.8 % (month 6), and 17.4 % (month 12). The proportion of patients in the cohort prescribed at least one first- and/or second-generation antidepressant was 50.2 % (month 0), 34.9 % (month 1), 27.5 % (month 3), 20.3 % (month 6), and 12.5 % (month 12). The proportion of patients receiving at least one benzodiazepine was 58.0 % (month 0), 36.7 % (month 1), 27.1 % (month 3), 20.0 % (month 6), and 12.0 % (month 12). The proportion of patients receiving an antidepressant as monotherapy was only 12.0 % (month 0), 7.8 % (month 1), 6.5 % (month 3), 4.8 % (month 6), and 2.9 % (month 12), whereas the proportion of patients treated with a benzodiazepine alone was 13.5 % (month 0), 6.9 % (month 1), 4.6 % (month 3), 3.5 % (month 6), and 2.7 % (month 12). Various combinations of polypharmacy were observed. The most common was a combination of at least one antidepressant and benzodiazepine, which was prescribed to 36.7 % (month 0), 25.8 % (month 1), 19.9 % (month 3), 14.9 % (month 6), and 9.2 % (month 12) of the cohort.

Conclusions

Based on analysis of prescription patterns and type of treatment used for treating non-psychotic major depression, a majority of patients were not treated according to the recommended guidelines in Japan. Various patterns of prescription and use of polypharmacy were observed over time. The median duration of treatment was shorter than the recommendation (6 months) in the guidelines.

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Acknowledgment

No sources of funding were used to assist in the conduct of this study or the preparation of the manuscript. TAF has received honoraria for speaking at CME meetings sponsored by Asahi Kasei, Eli Lilly, GlaxoSmithKline, Mochida, MSD, Otsuka, Pfizer Shionogi, and Tanabe-Mitsubishi. He is a diplomate of the Academy of Cognitive Therapy. He has received royalties from Igaku-Shoin, Seiwa-Shoten, and Nihon Bunka Kagaku-sha. He is on the advisory board for Sekisui Chemicals and Takeda Science Foundation. The Japanese Ministry of Education, Science, and Technology, the Japanese Ministry of Health, Labor and Welfare, and the Japan Foundation for Neuroscience and Mental Health have funded his research projects. SH has received honoraria for a luncheon meeting as a speaker at the Annual Meeting of Japanese Cancer Association by Sanofi K.K. He has received honoraria for speaking at the J-CaPURE joint meeting supported by Takeda Pharmaceutical Co. Ltd. He has received honoraria for an evening seminar at Annual Meeting of the Japanese Society of Urolithiasis Research sponsored by Astra Zeneca K.K. He has received honoraria for an educational lecture at the Japanese Society of BCG Instillation Therapy sponsored by Japan BCG Laboratory. The Japanese Ministry of Education, Science, and Technology, and the Japanese Ministry of Health, Labor and Welfare have funded his research projects. KK has received a grant from Dainippon Sumitomo Pharma Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Olympus Corporation, and Taiho Pharmaceuticals Co., Ltd. He has received honoraria from Daiichi Sankyo Company, Ltd, Behringer Ingelheim Japan, Inc., Senju Pharmaceuticals Co., Ltd, Toray industries Inc., Maruho Co., Ltd, Canon Inc., Olympus Corporation, Kyowa Hakko Kirin Co., Ltd, Kaken Pharmaceutical Co., Ltd, Novartis K.K., Otsuka Pharmaceuticals Co., Ltd, and Eisai Co., Ltd. He has received honoraria for lectures from the Japan Medical Data Center Co., Ltd. YO is an employee at Sanofi.

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Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Sakyo-ku, Kyoto, 606-8501, Japan

    Yoshie Onishi, Shiro Hinotsu & Koji Kawakami

  2. Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto, Japan

    Toshiaki A. Furukawa

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  1. Yoshie Onishi
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  2. Shiro Hinotsu
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  3. Toshiaki A. Furukawa
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Correspondence to Koji Kawakami.

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Onishi, Y., Hinotsu, S., Furukawa, T.A. et al. Psychotropic Prescription Patterns Among Patients Diagnosed With Depressive Disorder Based on Claims Database in Japan. Clin Drug Investig 33, 597–605 (2013). https://doi.org/10.1007/s40261-013-0104-y

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