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Cited by 206Treatment of Major DepressionMental Health Treatment and AccessPsychological Treatments and Disorders

National prescription patterns of antidepressants in the treatment of adults with major depression in the us between 1996 and 2015: a population representative survey based analysis

Open access
Luo, Yan, Kataoka, Yuki, Ostinelli, Edoardo G., Cipriani, Andrea, Furukawa, Toshi A.·2020·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2020.00035PMC PMC7033625
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Abstract

Few studies have delineated the real-world, long-term trends of prescription patterns of antidepressants for patients with major depressive disorder (MDD). This study aims to describe their vicissitudes in the nationally representative sample of the US from 1996 to 2015 and explore their characteristics. We used the Medical Expenditure Panel Survey, a nationally representative database of the US population, between 1996 and 2015. We estimated the prevalence of MDD among adults, calculated the proportions of those on antidepressant treatment as well as those on specific drugs through the two decades, and determined their dosages in 2015. We conducted multivariable regression to find possible factors related to their suboptimal prescriptions. The prevalence of adults diagnosed with MDD increased from 6.1% (95% CI, 5.7-6.6%) in 1996 to 10.4% (9.7-11.1%) in 2015. The proportion of patients without any antidepressant therapy decreased but still accounted for 30.6% (28.3-33.1%) in 2015. Sertraline and fluoxetine were among the most frequently prescribed antidepressants throughout the 20 years, while the trend for some new drugs changed dramatically. 16.1% (12.5-20.2%) of patients of MDD on antidepressant monotherapy were prescribed with suboptimal doses in 2015; the risk was lower for those who had higher Body Mass Index (OR 0.94 [0.90-0.99]), longer-term prescriptions (OR 0.92 [0.87-0.97]), and the risk was higher for those who were prescribed with tricyclic antidepressants (OR 11.21 [2.12-59.34], compared with serotonin reuptake inhibitors (SSRIs)), and antidepressants other than SSRIs and serotonin and norepinephrine reuptake inhibitors (OR 4.12 [1.95, 8.73], compared with SSRIs). This study confirmed the growing numbers of patients with MDD and the increase in the antidepressant prescriptions among them. However, the existence of patients without any antidepressant prescriptions or with suboptimal prescriptions and the variable prescription patterns through the decades might suggest some unresolved gaps between evidence and practice.

AI snapshot

Written from the paper’s full text.

TL;DR

Using nationally representative MEPS data from 1996–2015, this study found rising diagnosed MDD prevalence and antidepressant prescribing among US adults, but in 2015 30.6% of MDD patients received no antidepressant and 16.1% of monotherapy patients received suboptimal doses. Sertraline and fluoxetine were the most frequently prescribed antidepressants across the two decades, while prescription patterns for newer agents changed substantially.

Key findings

  • Adult MDD prevalence increased from 6.1% (95% CI 5.7–6.6%) in 1996 to 10.4% (9.7–11.1%) in 2015.
  • The proportion of MDD patients receiving no antidepressant decreased over time but remained 30.6% (28.3–33.1%) in 2015.
  • Among MDD patients on antidepressant monotherapy in 2015, 16.1% (12.5–20.2%) were prescribed suboptimal doses; higher BMI (OR 0.94 [0.90–0.99]) and longer antidepressant duration (OR 0.92 [0.87–0.97]) were associated with lower risk, while TCAs (OR 11.21 [2.12–59.34]) and antidepressants other than SSRIs/SNRIs (OR 4.12 [1.95–8.73]) were associated with higher risk compared with SSRIs.
  • Sertraline and fluoxetine were among the most frequently prescribed antidepressants throughout the 20 years; long-term antidepressant use increased, with 43.9% on antidepressants for more than 5 years in 2015 versus 13.4% in 1996.

Methods

  • Repeated cross-sectional analysis of the household component of the Medical Expenditure Panel Survey (MEPS), a nationally representative US survey, using data every five years from 1996 to 2015 (1996, 2000, 2005, 2010, 2015).
  • Adults aged ≥18 years with MDD were identified by ICD-9 codes 296.2, 296.3, or 311; bipolar disorder patients were excluded. Antidepressants were grouped into TCAs, SSRIs, SNRIs, and “No Pharm Class.”
  • Analyses used sampling weights to produce national estimates; trends were presented descriptively, and 2015 dose data were used to estimate average daily doses and identify suboptimal prescriptions, with crude, adjusted, and multivariable logistic regression for factors associated with suboptimal dosing.

Limitations

  • The paper states that prescriptions differ from actual consumption; MEPS lacks depression severity, treatment response, and prescriber specialty; some variables such as medication quantity were often missing; diagnosis depends mainly on patient report; combination antidepressant treatment was difficult to define; and incident versus chronic patients could not be distinguished.
  • The paper also notes that dose analysis data were incomplete for 43.1% of MDD patients on antidepressant monotherapy, and that trends were descriptive rather than statistically compared because survey methodology changed over time.
  • Evident from the text: the observational design cannot establish causality, and the inability to assess baseline severity or treatment course limits judgments about appropriateness of prescribing or not prescribing antidepressants in individual cases.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpsyt.2020.00035

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 42 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Sertraline and fluoxetine were among the most frequently prescribed antidepressants for MDD throughout 1996-2015.

    “Sertraline and fluoxetine were among the most frequently prescribed antidepressants throughout the 20 years”
    • Also stated in: § Prescription Patterns of Antidepressant Monotherapy Among Patients With MDD Over the Years · plain
      “Sertraline and fluoxetine were among the most prescribed antidepressants throughout the whole 20 years, with the absolute prescriptions increasing but prescription percentages decreasing, perhaps due to the introduction of more and more new drugs into the market in these years.”
    Quote in the paperSubstantial claim
  • Findingown data

    The prevalence of major depressive disorder among US adults increased from 6.1% (95% CI 5.7-6.6%) in 1996 to 10.4% (95% CI 9.7-11.1%) in 2015.

    “The prevalence of adults diagnosed with MDD increased from 6.1% (95% CI, 5.7–6.6%) in 1996 to 10.4% (9.7–11.1%) in 2015.”
    • Also stated in: § Numbers of Patients With MDD and Their Antidepressant Treatment Over the Years · plain
      “Prevalence of MDD among the adult population was 6.1% (95% CI, 5.7 to 6.6%) in 1996, which has increased steadily up to 2015, when it reached 10.4% (95% CI, 9.7 to 11.1%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The sex ratio of MDD patients on antidepressant monotherapy was roughly steady, with approximately 70% being women.

    “The sex ratio was roughly steady, with approximately 70% being women.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Estimated numbers of patients diagnosed with MDD showed a constant increase over 1996-2015.

    “Estimated numbers of patients diagnosed with MDD showed constant increase (Figure 1).”
    Quote in the paperNot a substantial claim
  • Findingown data

    SSRIs remained steady at around 70% of antidepressant monotherapy prescriptions over the 20 years.

    “Looking at antidepressant classes, SSRIs remained steady at around 70% for the whole 20 years”
    Quote in the paperSubstantial claim
  • May combine two claims. 19
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Findingown data

    TCAs declined and SNRIs grew in antidepressant monotherapy prescriptions over the 20 years.

    “whereas TCAs were declining and SNRIs were growing all along (Figure 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Trazodone was consistently prescribed although relatively infrequently.

    “while some appeared be consistently prescribed although relatively infrequently (for example, trazodone).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Escitalopram achieved 18.7% of monotherapy prescriptions and ranked 2nd upon first appearance.

    “escitalopram (dominating 18.7% and ranking the 2nd upon first appearance)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, among patients on venlafaxine and paroxetine, 45.9% and 48.2% of prescriptions were long-term uses, respectively.

    “In 2015, for drugs known to cause discontinuation effect such as venlafaxine and paroxetine, almost 50% of their prescriptions (45.9 and 48.2%, respectively) were long-term uses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, 43.9% of MDD patients on antidepressant monotherapy had long-term prescriptions of more than 5 years, compared with 13.4% in 1996.

    “More patients had long-term prescriptions of antidepressants in 2015, with 43.9% on antidepressants for more than 5 years, compared with only 13.4% in 1996.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The proportion of MDD patients without any antidepressant treatment decreased from 47.8% in 1996 to 30.6% in 2015, with a low of 25.1% in 2010.

    “The proportion of patients without any antidepressant therapy decreased but still accounted for 30.6% (28.3–33.1%) in 2015.”
    • Also stated in: § Numbers of Patients With MDD and Their Antidepressant Treatment Over the Years · plain
      “Patients with a diagnosis of MDD who were not on any antidepressant treatment accounted for 47.8% (95% CI, 44.3 to 51.3%) of all patients in 1996, but the proportion gradually decreased to 25.1% (95% CI, 23.0 to 27.4%) in 2010 or 30.6% (95% CI, 28.3 to 33.1%) in 2015”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In 2015, among patients on fluoxetine, sertraline, and bupropion, 46.4%, 45.1%, and 44.3% of prescriptions were long-term uses, respectively.

    “However, drugs less likely to cause withdrawal symptoms, for instance, fluoxetine, sertraline and bupropion, also had 46.4, 45.1 and 44.3% of prescriptions that have been used for more than 5 years respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Citalopram achieved 12.4% of monotherapy prescriptions and ranked 4th upon first appearance.

    “citalopram (occupying 12.4% and ranking the 4th upon first appearance).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The existence of patients without any antidepressant prescriptions or with suboptimal prescriptions, and variable prescription patterns through the decades, might suggest unresolved gaps between evidence and practice.

    “However, the existence of patients without any antidepressant prescriptions or with suboptimal prescriptions and the variable prescription patterns through the decades might suggest some unresolved gaps between evidence and practice.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Population-based prescriptions of specific antidepressants targeting MDD and their changes over time have not been well known.
    • Rests on an assumption: The average doses for particular antidepressants prescribed as monotherapy in treating MDD in the US and the potential factors related to their under-prescription remain unclear.

  • May combine two claims.

    Interpretationown data

    The study confirmed growing numbers of patients with MDD and an increase in antidepressant prescriptions among them.

    “This study confirmed the growing numbers of patients with MDD and the increase in the antidepressant prescriptions among them.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some studies revealed that low dose prescriptions were especially related to primary care physicians.

    “Some studies further revealed that low dose prescriptions were especially related to primary care physicians, perhaps due to their concerns about the side effects related to TCAs, or the lack of confidence of those general practitioners (34, 38, 40).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Bauer, 2008, Prescribing patterns of antidepressants in Europe: results from the factors influencing depression endpoints research (FINDER) study, Eur Psychiatry source

      Not checked in the free run.

    • cites [38] Donoghue, 1996, The treatment of depression: prescribing patterns of antidepressants in primary care in the UK, Br J Psychiatry source

      Not checked in the free run.

    • cites [40] Mojtabai, 2008, National patterns in antidepressant treatment by psychiatrists and general medical providers: results from the national comorbidity survey replication, J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    APA guideline recommends antidepressants as first-line treatment also for mild patients.

    “An antidepressant was originally recommended as the initial treatment for patients with moderate to severe depression by several guidelines (8, 11, 12, 24), whereas APA guideline recommends antidepressant as the first-line treatment also for mild patients (10, 25).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Work Group on Major Depressive DisorderPractice Guideline for the Treatment of Patients with Major Depressive Disorder (Third Edition)2010

      Not checked in the free run.

    • cites [25] 2000, Practice guideline for the treatment of patients with major depressive disorder (revision), Am J Psychiatry

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Guidelines originally recommended antidepressants as initial treatment for patients with moderate to severe depression.

    “An antidepressant was originally recommended as the initial treatment for patients with moderate to severe depression by several guidelines (8, 11, 12, 24), whereas APA guideline recommends antidepressant as the first-line treatment also for mild patients (10, 25).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8] 1993, Practice guideline for major depressive disorder in adults, Am J Psychiatry source

      Not checked in the free run.

    • cites [11] Depression in adults: recognition and management NICE Guideline2009

      Not checked in the free run.

    • cites [12] 2015, Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 british association for psychopharmacology guidelines, J Psychopharmacol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In most countries in Europe, SSRIs were the class prescribed most frequently in 2004-2005, especially in France and the UK, whereas in Germany TCAs dominated.

    “In most countries in Europe, SSRIs were the class being prescribed most frequently in 2004–2005, especially in France and the UK, whereas in Germany TCAs dominated (34).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Bauer, 2008, Prescribing patterns of antidepressants in Europe: results from the factors influencing depression endpoints research (FINDER) study, Eur Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The combination antidepressant treatment was difficult to define.

    “In addition, the combination antidepressant treatment was difficult to define.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A recent meta-analysis found a positive dose-response up to the lower end of licensed dose ranges of various antidepressants, beyond which there was no further increase in efficacy but only a sharp increase in side effects.

    “A recent meta-analysis found a positive dose-response up to the lower end of licensed dose ranges of various antidepressants, beyond which there was no further increase in efficacy but only sharp increase in side effects (13).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Furukawa, 2019, Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis, Lancet Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All analyses were based on national estimates using sampling weights.

    “All the analyses were based on national estimates using sampling weights.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    For trend analysis, the authors presented trends descriptively rather than using statistical methods to give a P value because directly comparing datasets from different times needs caution.

    “Since the survey methodology such as sampling and weighting and the measured items were being constantly improved over the years, directly comparing datasets from different times needs caution. Hence for this trend analysis, instead of employing statistical methods to give a P value, we opted rather to present the trends in a descriptive way.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Some important information was not recorded in MEPS, such as depression severity or treatment responses, the specialty of the doctor who prescribes a certain drug.

    “Although the MEPS is a large survey database with rigorous methodology based on representative samples in the US, some important information was not recorded, such as depression severity or treatment responses, the specialty of the doctor who prescribers a certain drug, among others.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Two individual participant data meta-analyses indicated that patients with lower baseline severity achieve smaller improvement compared to placebo.

    “Two individual participant data meta-analysis (26, 27) indicated that patients with lower baseline severity would achieve smaller improvement compared to placebo.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Stone, 2018

      Not checked in the free run.

    • cites [27] Fournier, 2010, Antidepressant drug effects and depression severity: a patient-level meta-analysis, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A PHQ-2 cut-off of 3 was suggested by previous studies for depression screening.

    “a cut-off of 3 was suggested by previous studies to be used as depression screening (17).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Kroenke, 2003, The Patient Health Questionnaire-2: validity of a two-item depression screener, Med Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A more recent study found that the differential response of patients with different severity was due to larger improvement on non-core symptoms, and that baseline severity did not affect the efficacy for core depression symptoms.

    “However, a more recent study (28) found that the differential response of patients with different severity was due to larger improvement on non-core symptoms, and that baseline severity did not affect the efficacy for core depression symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Hieronymus, 2019, Impact of baseline severity on the effects of selective serotonin reuptake inhibitors in depression: an item-based patient-level post hoc analysis, Lancet Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    K6 scores of 13 or more indicate serious psychological stress.

    “Scores at 13 or more has been shown to indicate serious psychological stress (18, 19).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] Kessler, 2002, Short screening scales to monitor population prevalences and trends in non-specific psychological distress, Psychol Med source

      Not checked in the free run.

    • cites [19] Kessler, 2003, Screening for serious mental illness in the general population, Arch Gen Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A few studies suggested that older antidepressants such as TCAs were more susceptible to be prescribed in low doses.

    “A few studies suggested that older antidepressants such as TCAs were more susceptible to be prescribed in low doses (34, 38, 39), which was consistent with our study.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Bauer, 2008, Prescribing patterns of antidepressants in Europe: results from the factors influencing depression endpoints research (FINDER) study, Eur Psychiatry source

      Not checked in the free run.

    • cites [38] Donoghue, 1996, The treatment of depression: prescribing patterns of antidepressants in primary care in the UK, Br J Psychiatry source

      Not checked in the free run.

    • cites [39] Rosholm, 1993, Outpatient utilization of antidepressants: a prescription database analysis, J Affect Disord source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was registered at UMIN Clinical Trials Registry (identifier UMIN000031898).

    “It was registered at UMIN Clinical Trials Registry (identifier: UMIN000031898).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    It was not possible to distinguish incident patients from chronic patients, so both acute phase and maintenance treatment were included in the analyses.

    “It was also not possible to distinguish incident patients from chronic patients therefore both acute phase and maintenance treatment were included in our analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In recent years, practice guidelines started to give more specific recommendations regarding classes or within-class types of antidepressants.

    “practice guidelines in recent years started to give more specific recommendations regarding the classes or even within-class types of medications (10–12).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [10] Work Group on Major Depressive DisorderPractice Guideline for the Treatment of Patients with Major Depressive Disorder (Third Edition)2010

      Not checked in the free run.

    • cites [11] Depression in adults: recognition and management NICE Guideline2009

      Not checked in the free run.

    • cites [12] 2015, Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 british association for psychopharmacology guidelines, J Psychopharmacol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The diagnosis in the household component of the MEPS is mainly dependent on patients' report.

    “For instance, the diagnosis in the household component of the MEPS is mainly dependent on patients' report.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The study's prevalence estimate was in line with epidemiological studies from the same periods.

    “The prevalence of adult major depression estimated in our study was between 6.1 and 10.4% from 1996 to 2015, which was in line with the epidemiological studies from the same periods (20–23).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [20] Kessler, 2003, The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R), JAMA source

      Not checked in the free run.

    • cites [21] Compton, 2006, Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002, Am J Psychiatry source

      Not checked in the free run.

    • cites [22] Hasin, 2005, Epidemiology of major depressive disorder: results from the national epidemiologic survey on alcoholism and related conditions, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [23] Kessler, 2013, The epidemiology of depression across cultures, Annu Rev Public Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Antidepressants play a key role in the treatment of MDD due to their demonstrated efficacy and wide availability.

    “Antidepressants play a key role in the treatment of MDD due to their demonstrated efficacy (6, 7) and wide availability.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Cipriani, 9665, Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis, Lancet source

      Not checked in the free run.

    • cites [7] Cipriani, 2018, Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis, Lancet source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the US, an old study based on office-based physician survey depicted the trend of antidepressant prescriptions for depression up to 2001, by which time SSRIs had clearly outnumbered TCAs.

    “In the US an old study (33) based on office-based physician survey depicted the trend of antidepressant prescriptions for depression up to 2001, by which time SSRIs had clearly outnumbered TCAs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Stafford, 2001, National patterns of medication treatment for depression, 1987 to 2001, Prim Care Companion J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The sensitivity of a broader diagnosis in mental health disorders reported is above 90%, but the specific diagnosis might be less certain.

    “Although the sensitivity of a broader diagnosis in mental health disorders reported is above 90%, the specific diagnosis might be less uncertain, as addressed in a case study (41).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Machlin, 2009, Sensitivity of household reported medical conditions in the medical expenditure panel survey, Med Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Asia, SSRIs dominated in almost every country, but particular prescription preferences differed from country to country.

    “In Asia, though SSRIs dominated in almost every country, the particular prescription preferences were different from country to country (35–37).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [35] Chee, 2015, International study on antidepressant prescription pattern at 40 major psychiatric institutions and hospitals in Asia: A 10-year comparison study, Asia Pac Psychiatry source

      Not checked in the free run.

    • cites [36] Uchida, 2007, International study on antidepressant prescription pattern at 20 teaching hospitals and major psychiatric institutions in East Asia: analysis of 1898 cases from China, Japan, Korea, Singapore and Taiwan, Psychiatry Clin Neurosci source

      Not checked in the free run.

    • cites [37] Grover, 2013, IPS multicentric study: Antidepressant prescription patterns, Indian J Psychiatry source

      Not checked in the free run.

33 of 33

  • The paper relies on this without support.

    Population-based prescriptions of specific antidepressants targeting MDD and their changes over time have not been well known.

    “Unfortunately, however, such details have not been well known, especially the population-based prescriptions of specific antidepressants targeting MDD and their changes over the time.”

  • The paper relies on this without support.

    The average doses for particular antidepressants prescribed as monotherapy in treating MDD in the US and the potential factors related to their under-prescription remain unclear.

    “The average doses for particular antidepressants prescribed as monotherapy in treating MDD in the US and the potential factors related to their under-prescription remain unclear.”

  • The paper relies on this without support.

    Most population-based prescription studies are based on claims databases where diagnoses were uncertain.

    “In the literature, most population-based prescription studies are based on claims databases where the diagnoses were uncertain, while small cohort studies of patients with established diagnoses were usually institution-based with short-term follow-up and therefore had problems in generalizability.”

  • The paper relies on this without support.

    Small cohort studies of patients with established diagnoses were usually institution-based with short-term follow-up and therefore had problems in generalizability.

    “In the literature, most population-based prescription studies are based on claims databases where the diagnoses were uncertain, while small cohort studies of patients with established diagnoses were usually institution-based with short-term follow-up and therefore had problems in generalizability.”

  • The paper relies on this without support.

    The MEPS is a large survey database with rigorous methodology based on representative samples in the US.

    “Although the MEPS is a large survey database with rigorous methodology based on representative samples in the US, some important information was not recorded, such as depression severity or treatment responses, the specialty of the doctor who prescribers a certain drug, among others.”

  • The paper relies on this without support.

    Prescription of antidepressants is different from their real consumption.

    “First, prescription of antidepressants is actually different from their real consumption.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • 2005 long-term-use percentage is too low for its count

    Minor

    The table reports 1,270,383 patients with at least five years of antidepressant use as 9.3% in 2005. That count is already 12.04% of all 10,548,016 monotherapy patients; excluding patients with missing duration data would make the percentage higher, not lower.

    Reported 9.3 · recomputed 12.04381

  • 2015 K6 counts do not match their percentages

    Minor

    The two 2015 K6 groups total 11,546,846 patients. Their listed counts therefore correspond to approximately 85.2% below 13 and 14.8% at or above 13, rather than the reported 86.3% and 13.7%.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Work Group on Major Depressive DisorderPractice Guideline for the Treatment of Patients with Major Depressive Disorder (Third Edition)2010
  2. Stone, 2018, Components and Trends in Treatment Effects in Randomized Placebo-controlled Trials in Major Depressive Disorder from 1979-2016

Cited by

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Related

Authors
Luo, Y., Kataoka, Y., Ostinelli, E. G., Cipriani, A., & Furukawa, T. A.
Affiliations
  • Kyoto University (JP)
  • Hyogo Prefectural Amagasaki General Medical Center (JP)
  • University of Milan (IT)
  • Warneford Hospital (GB)
Corresponding author
Furukawa, Toshi A.
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2020-02-14
Volume
11
Pages
171-171
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2020.00035
PMC
PMC7033625
OpenAlex
W3003710034
Semantic Scholar
a142bd2ac816a966cc052091d8512ae21f30abd1
Cited by
206
References
38
Citations by year
2026: 13 · 2025: 44 · 2024: 44 · 2023: 33 · 2022: 39 · 2021: 25 · 2020: 8
FWCI
15.73
Type
journal article
Language
en
Update notices
corrigendum (2020-03-06)
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Japan Society for the Promotion of Science
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Keywords
major depressive disorder, antidepressant prescribing, prescribing patterns, suboptimal dosing, antidepressant monotherapy, sertraline, fluoxetine, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, depression prevalence, treatment gap, Medical Expenditure Panel Survey

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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