Real‐World Status of Augmentation Therapy With Atypical Antipsychotics in Major Depressive Disorder: A Claims Database Study

BACKGROUND: This study investigated pharmacotherapy treatment patterns, focusing on atypical antipsychotics (AAP) augmentation therapy, in patients with major depressive disorder (MDD) who initiated antidepressant monotherapy in Japan. METHODS: This retrospective cohort study was conducted using a large Japanese claims database. Patients with MDD aged ≥ 18 years who were subsequently prescribed antidepressants between June 2013 and June 2020 were enrolled. We identified patients who initiated antidepressant monotherapy as the first line of treatment (LOT1). Treatment patterns, including the number, duration, and sequence of LOTs, were examined before and after AAP augmentation therapy. RESULTS: In total, 50 355 patients received antidepressant monotherapy in LOT1; the most common therapy was selective serotonin reuptake inhibitors (SSRIs). The use of AAP augmentation therapy increased with progression of LOTs. Overall, 3811 patients (7.6%) received AAP augmentation therapy after a mean of 1.4 LOTs and 270 days from treatment initiation. Although 37.9% of these patients changed to other treatments in the next LOT within 180 days, 46.4% continued AAP augmentation therapy for ≥ 180 days. Among patients receiving antidepressant monotherapy in LOT1, 14.6% underwent ≥ 3 LOTs and the most common treatment pattern was SSRI-SSRI-SSRI. CONCLUSIONS: The proportion of patients receiving AAP augmentation therapy was low. Although few LOTs were required before AAP augmentation therapy, the claims-defined interval before AAP augmentation therapy was relatively long. Approximately half of the patients demonstrated prescription persistence with AAP augmentation therapy for ≥ 180 days. These findings may help clinicians refine treatment strategies regarding the timing of AAP augmentation, providing a basis for future research on how such adjustments might influence therapeutic outcomes in MDD.