Published online Nov 19, 2021. doi: 10.5498/wjp.v11.i11.1116
Peer-review started: July 8, 2021
First decision: July 28, 2021
Revised: August 5, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 19, 2021
Processing time: 132 Days and 0.3 Hours
Subgrouping patients with major depressive disorder is a promising solution for the issue of heterogeneity. However, the link between available subtypes and distinct pathological mechanisms is weak and yields disappointing results in clinical application.
To develop a novel approach for classification of patients with time-dependent prescription patterns at first onset in real-world settings.
Drug-naive patients experiencing their first major depressive episode (n = 105) participated in this study. Psychotropic agents prescribed in the first 24 mo following disease onset were recorded monthly and categorized as antidepressants, augmentation agents, and hypnosedatives. Monthly cumulative doses of agents in each category were converted into relevant equivalents. Four parameters were used to summarize the time-dependent prescription patterns for each psychotropic load: Stability, amount, frequency, and the time trend of monthly prescriptions. A K-means cluster analysis was used to derive subgroups of participants based on these input parameters of psychotropic agents across 24 mo. Clinical validity of the resulting data-driven clusters was compared using relevant severity indicators.
Four distinct clusters were derived from K-means analysis, which matches experts’ consent: "Short-term antidepressants use", "long-term antidepressants use", "long-term antidepressants and sedatives use", and "long-term antidepressants, sedatives, and augmentation use". At the first 2 years of disease course, the four clusters differed on the number of antidepressants used at adequate dosage and duration, frequency of outpatient service use, and number of psychiatric admissions. After the first 2 years following disease onset, depression severity was differed in the four subgroups.
Our findings suggested a new approach to optimize the subgrouping of patients with major depressive disorder, which may assist future etiological and treatment response studies.
Core Tip: This study evaluated the time-dependent prescription patterns in drug-naive patients experiencing their first major depressive episode with data collected over the first 2 years after disease onset. The K-means clustering analysis was performed, along with the evaluation of four input parameters to generate data-based subgroups. Four feature-based clusters were identified, differentiated by the time-dependent prescription profiles and burden of the disease. Our novel parameters successfully captured the reciprocal interaction between physicians' prescriptions and disease status in a real-world setting. This study presents a novel clustering strategy that can be used to generate prescription-based subtypes.