Understanding the use of adjunctive atypical antipsychotics for major depressive disorder: an international cross-sectional survey of healthcare providers

Patients with major depressive disorder (MDD) can be prescribed atypical antipsychotics (AAPs) as adjunctive therapies but there is a lack of real-world evidence to understand prescribing decisions by healthcare providers (HCPs). This study describes the pharmacological prescribing patterns of HCPs for MDD, including AAPs, to better understand factors influencing decision-making.
An online cross-sectional survey was administered to HCPs treating patients with MDD in the United States (US), Canada, Brazil, and Japan. Data from the US and Canada are presented. HCPs were recruited between May-July 2024.
110 HCPs were included in the analysis (57 US, 53 Canada). HCPs indicated the typical next step for patients with mild/moderate/severe MDD with inadequate response to first-line treatment would be to augment the current antidepressant with an AAP (US: 47%/51%/68%; Canada: 62%/74%/79%). HCPs also report augmenting the current antidepressant with an AAP for patients with mild/moderate/severe MDD with inadequate response to second-line treatment (US: 49%/58%/67%; Canada: 79%/72%/81%). HCPs ranked the importance of selected symptom domains (underactive, overactive, and anxiety) when selecting optimal treatment (1 [not important]-10 [most important]). US/Canada HCPs ranked the following domains ≥8 in importance for treating patients with either an inadequate response to first (second) antidepressant treatment: 68%/57% (74%/55%) underactive (e.g., lack of concentration, low energy, lassitude), 70%/38% (74%/51%) overactive (e.g., irritability, agitation, hyperarousal), and 63%/59% (70%/59%) anxiety.
The findings demonstrate that HCPs across the US and Canada utilize augmentation with AAPs more frequently as severity of MDD increases and that symptom domains are viewed as increasingly important in later treatment lines.