Antidepressant Prescription for Major Depressive Disorder: Results from a Population-Based Study in Italy

Objectives: There is limited evidence about the factors influencing antidepressant (AD) prescription for the treatment of major depressive disorder (MDD) in Real World clinical practice in Italy. In this retrospective, population-based study, we set out to describe a patient cohort initiated on AD treatment for MDD and investigate the possible predictors of different ADs prescription in the primary care setting. Methods: Patients with a diagnosis of MDD who received an initial prescription of one of 11 selected ADs between 1-Apr-2017 and 31-Mar-2019 (index date) were identified from primary care electronic medical records in the Longitudinal Patient Database. Patients prescribed ≥1 AD in the 12 months before index date were excluded. Results were stratified by AD molecule. Multivariable logistic regression models estimated the association between patients' demographic, clinical factors, and choice of AD molecule. Results: The study cohort comprised 8,823 patients (67.1% female; mean age 61.6 years). Previous AD treatments (prescribed in the 10 years before index date) had been received by 46.6% of patients (non-naïve patients). The most commonly reported psychiatric and medical comorbidities reported in the 12 months before index date were anxiety (8.4%) and hypertension (41.9%), respectively. Patients' age was a significant predictor of AD molecule prescribed at index date in eight of the 11 molecules investigated while patients' gender influenced clinician prescribing of bupropion, citalopram, fluoxetine, fluvoxamine, sertraline, and vortioxetine. Conclusions: Results from this Real World study provide useful information for clinicians on the clinical factors influencing AD prescription in patients treated for MDD in primary care.