Study Reveals Anhedonia Impact on Symptom Severity and Treatment Outcomes in Patients With MDD
A recent retrospective cohort study presented in a poster at Psych Congress 2024 in Boston, Massachusetts, aimed to understand the characteristics and treatment patterns of patients with major depressive disorder (MDD) who experience prominent anhedonia (MDD-ANH) compared to those who do not or who have low levels of anhedonia (Other-MDD).
Hrishikesh Kale, BPharm, PhD, of Janssen Scientific Affairs, LLC, Titusville, NJ, and co-authors cited key study findings in the poster, “Significant clinical unmet need exists in patients with MDD with prominent anhedonia as reflected in higher symptom burden, higher use of antidepressants, and lower rate of remission."
A real-world dataset containing over 500,000 patients with MDD in the United States was sourced from electronic medical records and linked claims. The Patient Health Questionnaire 9-item (PHQ-9) was utilized to assess depression symptoms at baseline and over time among patients with MDD with MDD-ANH or Other-MDD. This data was collected between January 2013 and August 2023. Medications evaluated included first and second-generation antipsychotics, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, atypical antidepressants, and mood stabilizers.
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A total of 5709 patients diagnosed with MDD were included in the study, 4255 (74.5%) with MDD-ANH and 1454 (25.5%) with Other-MDD. At baseline, patients in the MDD-ANH group had a mean PHQ-9 score of 18.2 (SD=4.2) compared to 13.5 (SD=2.9) in the Other-MDD group. The study found that patients with MDD-ANH had lower remission rates at 4 follow-up intervals: 21.2% were in remission within 0-3 months, increasing to 30% by 9-12 months, compared to 27.0% to 32.6% in the Other-MDD group.
The study also highlighted the symptom burden, with patients in the MDD-ANH cohort reporting more frequent depressive symptoms at both baseline and at the 9-12 month follow-up.
Regarding treatment patterns, researchers revealed that patients with MDD-ANH were more likely to switch (odds ratio [OR]=1.24, p=0.004), augment their antidepressant therapy (OR=1.16, p=0.021), and receive combinations of antidepressant treatments (OR=1.23, p=0.004) compared to patients with Other-MDD. Patients with MDD-ANH were more likely to be treated with SNRIs (OR=1.29, p<0.001), tricyclic antidepressants (OR=1.31, p=0.003), atypical antidepressants (OR=1.24, p<0.001), mood stabilizers (OR=1.32, p<0.001), and second-generation antipsychotics (OR=1.51, p<0.001) during follow-up than Other-MDD patients.
The study had several limitations; researchers noted that the multi-source data may lead to incomplete patient information, with varying levels of missing data over time. Additionally, there is a “potential bias in the cohort selection toward more severe cases as patients who receive a PHQ-9 score at baseline have higher severity of depression than patients without PHQ-9 data.” These findings are also specific to MDD patients in psychiatric care rather than primary care settings.
Reference
Kale H, Severtson SG, Feldman BS, et al. Clinical burden of patients diagnosed with major depressive disorder with verses without prominent anhedonia using a real-world dataset in the United States. Psych Congress; October 31-November 1, 2024; Boston, Massachusetts.
