Burden of Prominent Anhedonia in Major Depressive Disorder Reflected in Polypharmacy, Healthcare Use and Humanistic Outcomes
Introduction: In patients with major depressive disorder (MDD), the effects of prominent anhedonia on psychotropic medication use, healthcare resource utilization (HCRU), and health-related quality of life (HRQoL) are not well understood.
Methods: Adults (≥18 years) with MDD (ICD-10-CM F32* or F33*) were identified from the Medical Expenditure Panel Survey (2016–2019). Anhedonia, using the first item of the Patient Health Questionnaire-2, was classified among respondents with MDD: prominent (“more than half the days”, “nearly every day”) (MDD-ANH) or other (“not at all”, “several days”) (other-MDD). Outcomes included psychotropic polypharmacy (concomitant use ≥2 psychotropic medications), HCRU, and HRQoL (SF-12 Physical and Mental Component Summary [PCS, MCS]) scores.
Results: Among individuals with MDD-ANH (n= 1075) and other-MDD (n=4037), psychotropic polypharmacy was higher in MDD-ANH vs other-MDD (43.2% vs 27.8%), as was polypharmacy in combination with antidepressants, including: mood stabilizers (13.0% vs 7.1%), antipsychotics (6.2% vs 2.9%), anxiolytics (6.5% vs 3.2%), and attention-deficit hyperactivity disorder medications (7.1% vs 4.3%). HCRU was higher in MDD-ANH vs other-MDD, including: emergency visits (33.1 vs 22.6 per 100 individuals), office visits (1305.2 vs 896.9 per 100 individuals), and hospitalizations (14.3 vs 9.9 per 100 individuals). HRQoL was lower in individuals with MDD-ANH vs other-MDD (PCS: 46.2 vs 50.3, MCS: 30.9 vs 47.1).
Conclusion: Prominent anhedonia in MDD was associated with higher likelihood of polypharmacy, higher use of healthcare services, and lower HRQoL. Findings suggest that anhedonia severity should be considered in routine assessment of MDD; identifying targeted treatments may reduce clinical and humanistic burden associated with MDD.
