(A-101) Salient features and related variables with the possibility of initial antidepressant modification: A prospective study in a tertiary-care teaching hospital in India

Background: For improved outcomes, treatment for Major Depressive Disorder (MDD) must begin within the first month of diagnosis. According to international recommendations, an initial antidepressant (IAD) trial should last 4–12 weeks at an optimal dose in order to elicit a response. Guidelines suggest changing, enhancing, or combining techniques as the next course of action if depressed symptoms continue beyond this time. Negative effects may result from stopping IAD too soon because it is ineffective. As a key goal, we sought to ascertain the frequency and trends of tactics used following an IAD modification due to a suboptimal response. The median survival time on IAD prior to any modification and the factors linked to IAD change were secondary outcomes.

Objectives: To ascertain the frequency and trends of approaches used following an IAD modification due to a less than ideal reaction to reducing the primary outcome of depression symptoms. The frequency and percentages of various modification techniques applied to the IAD following suboptimal response at various time points, the median survival time on IAD prior to any change, and potential risk or protective factors linked to the likelihood of IAD change were also examined as secondary outcomes.

Methods: This prospective, observational study was carried out in an Indian tertiary care hospital's psychiatry outpatient department. The dataset was gathered from October 1, 2023, to September 30, 2024. Criteria for inclusion and exclusion were established and used. In addition to the mean and standard deviation, descriptive statistics were presented as frequencies and percentages. Using survival analysis, the median time of IAD to modifying strategy was determined. A number of cox regression models were used to analyze related predictors.

Results: Of the 476 patients who fulfilled the study's inclusion requirements, 405 (85%) experienced an IAD change in any method before to the study's conclusion. 207 (51%); 95% CI [46–54%]) of the sample had an IAD change of less than or equal to 30 days. With a 95% CI of [35.4–53.9], the median time to IAD modification was 45 days. Younger age, not optimizing the IAD dose prior to any change, and concomitant anxiety were the characteristics statistically linked to a higher risk of IAD change.

Conclusions: In order to ensure that patient-therapy aims are met, measures must be made to prevent treatment failure, as over half of the patients in this study altered their IAD as early as inside the first month. Our research provided some hints to help physicians determine the high-risk factors associated with short survival and future IAD failure.