Major Depressive Disorder With Insomnia Presents Treatment Goal Challenges

Insomnia is associated with higher use of antidepressants, particularly those with sedative effects, according to a poster presented at this week’s 2023 American Psychiatric Association annual meeting. The treatment profiles for patients with major depressive disorder with insomnia (MDDIS) highlight the challenge of balancing the goals of promoting nighttime sleep and reducing daytime drowsiness. 

“Patients with MDDIS compared to those with other MDD and those without MDD have higher
healthcare resource utilization owing to mental health, cardiovascular, and metabolic conditions,” researchers said in the poster presentation. This suggests that “the burden of MDDIS extends beyond the mental health domain. MDDIS patients have higher [health care resource utilization (HRU)] across mental health, cardiovascular, and metabolic domains, indicating that the burden of MDDIS extends beyond mental health alone.”

This study aimed to describe and compare treatment patterns and HRU among commercially insured individuals with MDDIS, individuals with MDD but without insomnia (other MDD), and individuals without MDD (non-MDD). The data source used for the study was the IBM MarketScan Commercial Database, which includes demographic information, health plan enrollment data, and fully adjudicated medical claims for a wide range of services across the United States.

With a total of 52,280 patients included in each cohort after matching, this retrospective study analyzed treatment patterns based on pharmacy claims and HRU based on medical claims. Claims were split into the following categories: mental health-related, cardiovascular-related, and metabolic-related.

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MDDIS patients were more likely to claim any antidepressant medication compared to the other MDD cohort, the study found. Those patients were also twice as likely to have antidepressant polypharmacy and over 3 times more likely to claim 3 or more unique antidepressants simultaneously.

Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed antidepressants for both cohorts, but the MDDIS cohort had a 14% higher risk of being prescribed SSRIs compared to the other MDD cohort. Trazodone, a sedating serotonin modulator, was the most prescribed antidepressant in the MDDIS cohort, with a significantly higher risk compared to the other MDD cohort.

Regarding HRU, the MDDIS cohort had a higher risk of mental health-related, cardiovascular-related, and metabolic-related inpatient admissions, emergency visits, and outpatient visits compared to the other MDD and non-MDD cohorts.

The study authors noted a few limitations, including the potential lack of generalizability to uninsured individuals or those with different health plans. The study also relied on claims data, which may not fully capture all MDD and insomnia diagnoses and medications.

Reference
Zhdanava M, Drissen T, Boonmak P, Kale H, Jha M. Comparative treatment patterns among commercially insured patients with major depressive disorder with insomnia. Poster presented APA 2023 Annual Meeting; May 20-24, 2023.