A survey of five antidepressant properties influencing clinician’s treatment choices in MDD

George I Papakostas, Lindsay A Hallett, Juliana Smith, Eliana Tossani, Alessandra Mascarini, Alana M Burns, Robert J Birnbaum, Maurizio Fava, Jonathan E Alpert

Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Introduction: The goal of the present work was to examine how clinicians’ perceptions of the properties of antidepressants may influence their choice of antidepressants when treating major depressive disorder (MDD).

Methods: 273 of 682 (40%) clinicians attending a psychopharmacology review course responded to a questionnaire designed to explore their practices and perceptions with regards to antidepressant pharmacotherapy.

Results: Most clinicians ranked efficacy (57.3%) as the most important factor when selecting  antidepressants, followed by safety (23.0%), tolerability (9.4%), rapidity of action (5.2%), and cost (4.9%). However, when presented with hypothetical scenarios in which there was a difference in efficacy between two antidepressant agents, the relative safety, tolerability, and cost of the two agents significantly influenced the likelihood of choosing one antidepressant over another. In fact, clinicians required progressively greater differences in efficacy between two agents in order to select one antidepressant over another given a difference in terms of their safety than tolerability, or their tolerability than cost (p < 0.0001 all comparisons).

Conclusions: When selecting an antidepressant, clinicians appear to be most influenced by efficacy, followed by safety. Rapidity of action and cost may be less salient considerations in clinical practice. Further research is necessary to elucidate factors that influence clinicians’ choice of antidepressants.

Keywords: depression, antidepressant, prescribing, preferences, survey