Clinical Burden of Patients Diagnosed with Major Depressive Disorder with Versus without Prominent Anhedonia Using a Real-World Dataset in the United States

Anhedonia is a core feature of major depressive disorder (MDD) yet its clinical burden on patients is not well understood. This retrospective cohort study assessed depression symptoms and treatment patterns among MDD cohorts with and without prominent anhedonia from January 2013 through August 2023. Patients were selected from a real-world dataset of MDD patients with linked claims and electronic medical records (OM1, Inc. Boston MA). Patients with the first Patient Health Questionnaire 9-items (PHQ-9) score of ≥10 within one month of their first MDD diagnosis were included. Patients with a score ≥2 on PHQ-9 item 1 (anhedonia) at baseline were classified as MDD with prominent anhedonia (MDD-ANH) (n=4,255). All other patients were classified as other-MDD(n=1,454). Treatment patterns were assessed using prescription records in the year following the first PHQ-9 score. Symptom burden (PHQ-9 total score) and remission (PHQ-9 total score < 5) were assessed during four follow-up time windows. The mean baseline PHQ-9 score was 18.2 (SD=4.2) for MDD-ANH patients and 13.5 (SD=2.9) for other-MDD patients. Patients with MDD-ANH received more antidepressant medications (RR=1.11, p < 0.001) and were more likely to be treated with atypical antipsychotics (OR =1.54, p=0.008) than other-MDD patients during follow-up. The percentage of patients in remission was lower among MDD-ANH patients (21.2%, 28.1%, 27.2%, and 30.0%) compared to other-MDD patients (27.0%, 32.9%, 33.1%, and 32.6%) at 0-3, 3-6, 6-9, and 9-12-months follow-up, respectively. During follow-up, MDD-ANH patients on average experienced more depressive symptoms, received more treatments, and were less likely to achieve remission than other-MDD patients.