Authors: D H Boskovic, S Kapadia, F Ardic, D F Eisenberg, J Hickey, O Rogerson, F Glen
Published: Journal of Clinical Psychopharmacology, 2026
View publication
Purpose
The aim of this study was to describe pharmacological prescribing patterns for major depressive disorder (MDD), particularly regarding the use of atypical antipsychotics (AAPs) for the treatment of MDD, and the underlying factors that may influence decision-making.
Methods
An electronic cross-sectional survey with 210 health care professionals (HCPs) involved in the treatment of MDD in 4 countries [United States (57), Canada (53), Brazil (39), Japan (61)] was conducted in May 2024 to July 2024.
Results
Of the total HCPs, 62.9% (n = 132) were psychiatrists, 31.9% (n = 67) primary care physicians or general practitioners, and 5.2% (n = 11) nurse practitioners or physician assistants. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed first-line antidepressants across all countries surveyed. Regardless of disease severity, the first step for patients with inadequate response to the first antidepressant treatment was reported to be switching to another antidepressant (mild MDD: 66.7%, moderate MDD: 56.2%, severe MDD: 41.0%). Overall, SSRIs were the most common treatment class, typically augmented with AAPs, followed by serotonin-norepinephrine reuptake inhibitors. HCPs across the countries surveyed increasingly utilized augmentation with AAPs as the severity of MDD increased, with the severity of the current depressive episode and the number of prior antidepressants being the most important patient and treatment factors, respectively, in this decision. In addition, symptom domains, particularly underactive noradrenergic/norepinephrinergic activity and anxiety, were deemed crucial by HCPs in later treatment lines.
Conclusions
The study highlighted complex treatment paradigms in MDD and the need for alternative therapeutic strategies and more tailored options that specifically target receptor pharmacology.
