Clinical Guideline (CANMAT 2016) Discordance of Medications for Patients with Major Depressive Disorder in China

Figures & data

Table 1 Comparison of Recommendation Level Between CANMAT 2016 and PTDDC 2015

	CANMAT 2016	PTDDC 2015
SSRIs	First line	First line
SNRIs	First line	First line
Mirtazapine	First line	First line
Bupropion	First line	First line
TCAs	Second line	Second line
Trazodone	Second line	Second line
Quetiapine	Second line	/
Benzodiazepines	Second line	/
Shuganjieyu capsule	/	Second line
St John’s Wort	/	Second line

Abbreviations: CANMAT 2016, Canadian Network for Mood and Anxiety Treatments 2016 Clinical Guidelines; PTDDC 2015, 2015 Guidelines for Prevention and Treatment of Depressive Disorder in China, second edition.

Table 2 Demographic and Clinical Information of the MDD Patients (n = 3269)

	Total (n = 3269)	First visit Patient (n = 1346)	Follow-up Visit Patient (n = 1923)
Age [Median(p25, p75)]	39.8 (31.0,50.8)	38.4 (29.2,45.9)	42.8 (32.6,53.5)
Gender (n, %)
Male	1289 (39.4)	550 (40.9)	739 (38.4)
Female	1973 (60.4)	791 (58.8)	1182 (61.4)
Missing data	7 (0.2)	5 (0.4)	2 (0.1)
Education level (n, %)
High School graduated	1840 (56.3)	705 (52.4)	1135 (59.0)
College degree	1185 (36.2)	551 (40.9)	634 (33.0)
Postgraduate degree	114 (3.5)	55 (4.1)	59(3.1)
Missing data	130 (4.0)	35 (2.6)	95 (4.8)
Number of episodes [Median(p25, p75)]	1 (1,2)	1 (1,1)	2 (1,3)
Treatment resistant depression (n, %)	153 (4.7)	14 (1.0)	139 (7.2)
Marrital status (n, %)
Unmarried	671 (20.5)	332 (24.7)	339 (17.6)
Married	2384 (72.9)	944 (70.1)	1440 (74.9)
Divorced	109 (3.3)	39 (2.9)	70 (3.6)
Widowed	69 (2.1)	16 (1.2)	53 (2.8)
Missing data	36 (1.1)	15 (1.1)	21 (1.1)
Vocational status (n, %)
Unemployed	749 (22.9)	273 (20.3)	476 (24.8)
Employed	1779 (54.4)	842 (62.6)	937 (48.7)
Student	200 (6.1)	95 (7.1)	105 (5.5)
Retired	443 (13.6)	104 (7.7)	339 (17.6)
Missing data	98 (3.0)	32 (2.4)	66 (3.4)
Patient setting (n, %)
Outpatient	2283 (69.8)	1137 (84.5)	1146 (59.6)
Inpatient	982 (30.0)	208 (15.5)	774 (40.2)
Missing data	4 (0.1)	1 (0.1)	3 (0.1)
Ethnicity (n, %)
Han population	3182 (97.3)	1314 (97.6)	1868 (97.1)
Non-Han population	66 (2.0)	22 (1.6)	44 (2.3)
Missing data	21 (0.6)	10 (0.7)	11 (0.6)

Table 3 Current Status of Antidepressant Treatment and Common Combined Antidepressants in 32 Centers

	Total First Therapy (n = 3269)	First Visit Patient (n = 1346)	First Therapy^a (n = 1923)	Current Therapy^a(n = 1923)
First-line recommendations
SSRIs total	1242 (38.0%)	489 (36.3%)	1099 (57.2%)	753 (39.2%)
SSRIs monotherapy^b	792 (24.2%)	362 (26.9%)	927 (48.2%)	430 (22.4%)
SNRIs total	1753 (53.6%)	716 (53.2%)	438 (22.8%)	1037 (53.9%)
SNRIs monotherapy	1259 (38.5%)	557 (41.4%)	333 (17.3%)	702 (36.5%)
Mirtazapine total	262 (8.0%)	73 (5.4%)	135 (7.0%)	189 (9.8%)
Mirtazapine monotherapy	51 (1.6%)	18 (1.3%)	50 (2.6%)	33 (1.7%)
Bupropion total	13 (0.4%)	5 (0.4%)	5 (0.3%)	8 (0.4%)
Bupropion monotherapy	3 (0.1%)	1 (0.1%)	3 (0.2%)	2 (0.1%)
Second-line recommendations
TCAs total	12 (0.4%)	3 (0.2%)	70 (3.6%)	9 (0.5%)
TCAs monotherapy	1 (0.03%)	0 (0)	45 (2.3%)	1 (0.1%)
Trazodone total	46 (1.4%)	13 (1.0%)	30 (1.6%)	33 (1.7%)
Trazodone monotherapy	4 (0.1%)	1 (0.1%)	3 (0.2%)	3 (0.2%)
Quetiapine total	0 (0)	0 (0)	1 (0.1%)	0 (0)
Quetiapine monotherapy	0 (0)	0 (0)	0 (0)	0 (0)
Chinese medicine^c monotherapy	1 (0.03%)	1 (0.1%)	6 (0.3%)	0 (0)
Shuganjieyu capsule	4 (0.1%)	0 (0)	6 (0.3%)	4 (0.2%)
St John’s Wort	1 (0.03%)	0 (0)	1 (0.1%)	1 (0.1%)
Without recommendations
Flupentixol and melitracen tablets monotherapy	31 (0.9%)	19 (1.4%)	48 (2.5%)	12 (0.6%)
Antipsychotics total	438 (13.4%)	107 (7.9%)	12 (0.6%)	331 (17.2%)
Antipsychotics monotherapy	5 (0.2%)	0 (0)	0 (0)	5 (0.3%)
Other traditional Chinese medicines	7 (0.2%)	1 (0.1%)	3 (0.2%)	6 (0.3%)
Mood stabilizers	202 (6.2%)	70 (5.2%)	1 (0.1%)	132 (6.9%)
Antidepressants+ benzodiazepines	1577 (48.2%)	601 (44.7%)	13 (0.7%)	976 (50.8%)
Antidepressants+ mood stabilizers	196 (6.0%)	69 (5.1%)	1 (0.1%)	127 (6.6%)
Antidepressants+ flupentixol and melitracen tablets	25 (0.8%)	16 (1.2%)	14 (0.7%)	9 (0.5%)
Commonly combined antidepressants (total)	334 (10.2%)	92 (6.8%)	173 (9.0%)	242 (12.6%)
SSRIs + SNRIs	87 (2.7%)	26 (1.9%)	65 (3.4%)	61 (3.2%)
SSRIs + mirtazapine	75 (2.3%)	12 (0.9%)	50 (2.6%)	63 (3.3%)
SNRIs + mirtazapine	132 (4.0%)	42 (3.1%)	37 (1.9%)	90 (4.7%)
SNRIs + trazodone	18 (0.6%)	6 (0.4%)	3 (0.2%)	12 (0.6%)
SSRIs + trazodone	22 (0.7%)	6 (0.4%)	18 (0.9%)	16 (0.8%)
Recommendations for Clinical Specifiers
Benzodiazepines^d	1619 (49.5%)	620 (46.1%)	31 (1.6%)	999 (52.0%)
Antidepressants+ antipsychotics^e	430 (13.2%)	107 (7.9%)	8 (0.4%)	323 (16.8%)

Notes: ^aAmong follow-up patients; ^bMonotherapy was defined as one subject with or without combination of benzodiazepine; ^cRecommended by the Chinese Guidelines; ^dCANMAT recommendation for MDD with catatonic features (Level 3); ^eCANMAT recommendation for MDD with psychotic features (Level 1).

Figure 1 Line chart of switching antidepressants in their first visit and follow-up visit of treatment (n = 1923). The sub-figures respectively show the first-line recommendations (a), the second-line recommendations (b) and the “without recommendations” list (c) by CANMAT 2016 and the Chinese medicine recommendations (d) by PTDDC 2015.

Figure 2 Statistics of psychotherapy or kind(s) of pharmacotherapy (n = 3269).