Comparative Responses to 15 Different Antidepressants in Major Depressive Disorder

Study Overview
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Brief Summary
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Achieving results from RCTs with high internal and external validity is a major challenge within psychiatry due to the nature of psychiatric illnesses. The Investigators will conduct a real world naturalistic nation-wide population-based longitudinal register linkage study comparing long-term responses to all kinds of antidepressants in patients with major depressive disorder emulating a randomized trial.

Official Title
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Comparative Responses to 15 Different Antidepressants in Major Depressive Disorder - Results From a Long-term Nation-wide Population-based Study Emulating a Randomized Trial

Conditions
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Major Depressive Disorder

Intervention / Treatment
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* Drug: Antidepressant


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients with a psychiatric contact (as inpatients or outpatients) in the period from 1995 to 2018 with a first main index diagnosis of a single depressive episode or recurrent depressive disorder (ICD-10 code: F32-F33.9) with an outpatient purchase of an antidepressant after the depression diagnosis (N=73.336). Exclusion Criteria: None.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| SSRI<br>Group 1: Selective serotonin reuptake inhibitors (reference: sertraline) Comparisons of the following with sertraline: Citalopram, Fluoxetine, Paroxetine, Escitalopram | Drug: Antidepressant<br>* Treatment with an antidepressant according to Danish register data.<br>* Other names: sertraline, citalopram, fluoxetine, paroxetine, escitalopram, reboxetine, venlafaxine, duloxetine, mirtazapine, vortioxetine, agomelatine, amitriptyline, imipramine;|
| NARI<br>Group 2: Noradrenaline reuptake inhibitors (reference: sertraline) Comparisons of the following with sertraline: Reboxetine | Drug: Antidepressant<br>* Treatment with an antidepressant according to Danish register data.<br>* Other names: sertraline, citalopram, fluoxetine, paroxetine, escitalopram, reboxetine, venlafaxine, duloxetine, mirtazapine, vortioxetine, agomelatine, amitriptyline, imipramine;|
| SNRI<br>Group 3: Serotonin and noradrenaline reuptake inhibitors (reference: venlafaxine) Comparisons of Duloxetine with venlafaxine | Drug: Antidepressant<br>* Treatment with an antidepressant according to Danish register data.<br>* Other names: sertraline, citalopram, fluoxetine, paroxetine, escitalopram, reboxetine, venlafaxine, duloxetine, mirtazapine, vortioxetine, agomelatine, amitriptyline, imipramine;|
| ARI<br>Group 4: Adrenergic receptor inhibitors (reference: Mirtazapine) Comparisons of Mianserin with Mirtazapine | Drug: Antidepressant<br>* Treatment with an antidepressant according to Danish register data.<br>* Other names: sertraline, citalopram, fluoxetine, paroxetine, escitalopram, reboxetine, venlafaxine, duloxetine, mirtazapine, vortioxetine, agomelatine, amitriptyline, imipramine;|
| Other drugs<br>Group 5: Other drugs (reference: sertraline) Comparisons of Vortioxetine and Agomelatine with sertraline | Drug: Antidepressant<br>* Treatment with an antidepressant according to Danish register data.<br>* Other names: sertraline, citalopram, fluoxetine, paroxetine, escitalopram, reboxetine, venlafaxine, duloxetine, mirtazapine, vortioxetine, agomelatine, amitriptyline, imipramine;|
| TCA<br>Group 6: Tricyclic antidepressants (reference: amitriptyline) Comparisons of Nortriptyline, Imipramine, Clomipramine and Dosulepin with amitriptyline | Drug: Antidepressant<br>* Treatment with an antidepressant according to Danish register data.<br>* Other names: sertraline, citalopram, fluoxetine, paroxetine, escitalopram, reboxetine, venlafaxine, duloxetine, mirtazapine, vortioxetine, agomelatine, amitriptyline, imipramine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Response | Response was defined as continuous monotherapy with an antidepressant drug without switch to or add-on of another antidepressant drug, an antipsychotic drug or lithium or hospitalization with a main ICD-10 diagnosis of a single depressive episode or recurrent depressive disorder . | 2 years |