Is There a Better Way to Choose an Antidepressant Medication Than Trial and Error?

Summary: Yes, a better way to choose an antidepressant medication than trial and error could be right around the corner. New research on patients with depression may contain good news.

Key Points:

Antidepressant medication works for some people, but not for others.
The process of choosing an antidepressant involves trial and error, to determine which medication works best for each individual.
This process can be time consuming and frustrating for patients with depressive disorders.
A new, automated, decision-making tool may improve the process of choosing antidepressant medication.

Not AI: A Computer-Based Decision-Making Tool for Antidepressant Medication

In the random-controlled trial “A Decision-Support System to Personalize Antidepressant Treatment in Major Depressive Disorder,” a group of researchers designed a study to answer this research question:

“Can a web-based clinical decision-support system combining clinical and demographic predictors with patient preferences to personalize antidepressant treatment, improve clinical outcomes of people with major depressive disorder?”

To find an answer, the research team recruited 520 adult patients with major depressive disorders (MDD) and divided them into two groups. One group was prescribed antidepressant medication using a tool called PETRUSHKA and the other was prescribed an antidepressant without using the PETRUSKA tool. the length of time they adhered to their medication to patients

The primary outcome researchers assessed was treatment discontinuation – i.e. stopping the medication – within 8 weeks of initiating the medication. Secondary outcomes included treatment discontinuation at 24 weeks due to adverse events or a change in depressive symptoms or symptoms of anxiety. Researchers measured depressive symptoms with the evidence-based depression metric, the Patient Health Questionnaire-9 (PHQ-9), and measured symptoms of anxiety with the evidence-based anxiety metric, the Generalized Anxiety Disorder-7 (GAD-7).

What is the PETRUSHKA Tool?

Here’s how the engineers and mental health experts who designed PETRUSHKA describe the why the tool is needed and a glimpse into how it works:

“People with a diagnosis of depression often need additional support when they make decisions about starting a new course of treatment. By a more careful analysis of existing data, we can better tailor the choice of a specific drug to a specific person to increase the chances that the drug will be tolerable and effective.”

There are two primary reasons people discontinue antidepressant medication after initiation:

It doesn’t reduce depressive symptoms.
The side effects are unwanted/intolerable.

The PETRSUCHKA tool focuses primarily on the second reason: eliminating/reducing intolerable side effects by collecting patient preference data before prescription. When a patient uses the PETRUSHKA, they rank the side effects they least want to experience by placing them in order of most likely to avoid. A list of symptoms in PETRUSHKA may look like this:

Constipation
Dizziness
Erectile dysfunction
Headache
Nausea
Diarrhea
Dry mouth
Fatigue
Lack of appetite
Sleepiness

Once they rank their least desired side effects, the tool generates a brief report that looks like this:

Antidepressant 1, % likelihood of symptoms:

Headache: 20%
Sleepiness: 8%
Diarrhea: 18%
Dry Mouth: 8%
Constipation: 5%

Antidepressant 2, likelihood of symptoms:

Headache: 20%
Sleepiness: 11%
Diarrhea: 23%
Dry Mouth: 10%
Constipation: 4%

Once they see the report, the patient can collaborate with their provider to make an informed decision about which antidepressant to choose, based on current symptoms, past treatment history, and the PETRUSHKA report.

Is PETRUSHKA a Better Way to Choose an Antidepressant than Trial and Error?

The short answer, based on this study of 520 adults, is yes. There is a better way to choose an antidepressant medication than trial and error.

Here’s what the results show.

Using PETRUSHKA vs. Not Using PETRUSHKA: Time to Discontinuation

Primary Outcome, discontinuation at 8 weeks:

PET: 17% discontinued medication
No PET: 27.4% discontinued medication

Secondary Outcomes:

Discontinuation at 24 weeks:
- PET: 34.4% discontinued medication
- No PET: 40.4% discontinued medication
Discontinuation due to adverse events:
- PET: 24.3% discontinued medication
- No PET: 34.6% discontinued medication

The data shows that use of the tool improved adherence to antidepressant medication. Here’s a helpful way of summarizing the data above:

Patients who used the PETRUSHKA tool had a 38% increased likelihood of staying on medication for at least 8 weeks, compared to patients who didn’t use PETRUSHKA.
Those who used the PETRUSHKA tool had a 15% increased likelihood of staying on medication for at least 24 weeks, compared to patients who didn’t use PETRUSHKA.
Patients who used the PETRUSHKA tool had a 41% reduced likelihood of discontinuing medication due to adverse events at 8 weeks post-treatment, compared to patients who didn’t use PETRUSHKA.
Those who used the PETRUSHKA tool had a 20% reduced likelihood of discontinuing medication at 24 weeks post-treatment, compared to patients who didn’t use PETRUSHKA

We’ll discuss these results below.

Precision Prescribing for Improved Outcomes

In mental health treatment, we often discuss the importance of an early, accurate diagnosis for people with mental health disorders. This supports this overall mental health treatment maxim:

The earlier a person who needs evidence-based treatment for a mental health disorder gets the evidence-based treatment they need, the better the long-term outcome.

For people with major depressive disorder, deciding which treatment they need – i.e. the one that works best for them – can be time consuming, resource-consuming, and frustrating. With a tool like this, we may be able to reduce the amount of trial and error involved in prescribing antidepressant medication, and offer faster symptom relief for patients with major depressive disorder (MDD).

That’s a big deal, and may represent a significant step forward in effective and efficient treatment for patients with depression.

Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.