The epidemiology of antidepressant use in South Korea: Does short-term antidepressant use affect the relapse and recurrence of depressive episodes?

Autoři: Min Ji Kim aff001;  Namwoo Kim aff001;  Daun Shin aff001;  Sang Jin Rhee aff001;  C. Hyung Keun Park aff001;  Hyeyoung Kim aff004;  Sung Joon Cho aff005;  Jae Won Lee aff006;  Eun Young Kim aff007;  Boram Yang aff009;  Yong Min Ahn aff001
Působiště autorů: Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea aff001;  Department of Psychiatry and Behavioral Science, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea aff002;  Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea aff003;  Department of Psychiatry, Inha University Hospital, Inhang-ro, Jung-gu, Incheon, Republic of Korea aff004;  Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea aff005;  Dept. of Psychiatry Seoul Metropolitan Eunpyeong Hospital, dept. of Psychiatry, Eunpyeong-gu, Seoul, Republic of Korea aff006;  Mental Health Center, Seoul National University Health Care Center, Gwanak-gu, Seoul, Republic of Korea aff007;  Department of Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea aff008;  Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South-Korea aff009
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222791



The duration of antidepressant use affects the treatment of depression. Using the National Health Insurance database, which covers almost the entire national population, we verified the factors associated with the inadequate short-term use of initially prescribed antidepressants and their effects on the relapse and recurrence of depressive episodes.


There were 752,190 patients included who had been newly prescribed antidepressants in 2012 with the diagnosis of depressive disorder. They were followed-up until December 31, 2015. They were classified as short-term and long-term antidepressant users depending on whether they used a specific initial antidepressant for at least four weeks. Sociodemographic, clinical, and medical utilization factors affecting the duration of antidepressant use were investigated. We also identified whether the duration of antidepressant use affected the risk of relapse and recurrence, which was defined by the restarting of antidepressants.


Initial antidepressants were taken for less than 28 days by 458,057 (60.84%) patients. Tricyclic antidepressants were used as the initial antidepressant more frequently than selective serotonin reuptake inhibitors (64.5% versus 19.3%). The type of initial antidepressant, polypharmacy, psychiatric and medical comorbidities, type of insurance coverage, and type of medical institution visited were associated with short-term use. Short-term use marginally increased the risk of relapse and recurrence of depressive episodes (Hazard ratio: 1.06, 95% confidence intervals 1.048–1.075).


Short-term antidepressant use is widespread in Korea, and assessment in various aspects are necessary to set proper treatment plans.

Klíčová slova:

Antidepressants – Cardiology – Depression – Health insurance – Mental health and psychiatry – Oncology – Pulmonology – Reuptake inhibitors


1. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The lancet. 1997;349(9063):1436–42.

2. Sayers J. The world health report 2001-Mental health: new understanding, new hope. Bulletin of the World Health Organization. 2001;79:1085–.

3. Vos T, Haby MM, Barendregt JJ, Kruijshaar M, Corry J, Andrews G. The burden of major depression avoidable by longer-term treatment strategies. Archives of General Psychiatry. 2004;61(11):1097–103. doi: 10.1001/archpsyc.61.11.1097 15520357

4. Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. The Lancet. 2003;361(9358):653–61.

5. Association AP. Practice guideline for the treatment of patients with major depressive disorder (3rd). http://psychiatryonlineorg/guidelinesaspx. 2009.

6. Bull SA, Hunkeler EM, Lee JY, Rowland CR, Williamson TE, Schwab JR, et al. Discontinuing or switching selective serotonin-reuptake inhibitors. Annals of Pharmacotherapy. 2002;36(4):578–84. doi: 10.1345/aph.1A254 11918502

7. Lin EH, Von Korff M, Katon W, Bush T, Simon GE, Walker E, et al. The role of the primary care physician in patients' adherence to antidepressant therapy. Medical care. 1995:67–74. doi: 10.1097/00005650-199501000-00006 7823648

8. Maddox J, Levi M, Thompson C. The compliance with antidepressants in general practice. Journal of Psychopharmacology. 1994;8(1):48–52. doi: 10.1177/026988119400800108 22298480

9. Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. American Journal of psychiatry. 2006;163(1):101–8. doi: 10.1176/appi.ajp.163.1.101 16390896

10. Lee KU, Kim W, Min KJ, Shin YC, Chung SK, Bahk WM. The rate and risk factors of early discontinuation of antidepressant treatment in patients with major depressive disorder. Korean Journal of Psychopharmacology. 2006;17(6):550–6.

11. Bull SA, Hu XH, Hunkeler EM, Lee JY, Ming EE, Markson LE, et al. Discontinuation of use and switching of antidepressants: influence of patient-physician communication. Jama. 2002;288(11):1403–9. doi: 10.1001/jama.288.11.1403 12234237

12. Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Archives of general psychiatry. 2001;58(1):55–61. doi: 10.1001/archpsyc.58.1.55 11146758

13. Rosholm J-U, Andersen M, Gram LF. Are there differences in the use of selective serotonin reuptake inhibitors and tricyclic antidepressants? A prescription database study. European journal of clinical pharmacology. 2001;56(12):923–9. doi: 10.1007/s002280000234 11317482

14. Simon GE, VonKorff M, Wagner EH, Barlow W. Patterns of antidepressant use in community practice. General hospital psychiatry. 1993;15(6):399–408. doi: 10.1016/0163-8343(93)90009-d 8112564

15. Anderson I, Tomenson B. Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. Bmj. 1995;310(6992):1433–8. doi: 10.1136/bmj.310.6992.1433 7613276

16. Tai-Seale M, Croghan TW, Obenchain R. Determinants of antidepressant treatment compliance: implications for policy. Medical Care Research and Review. 2000;57(4):491–512. doi: 10.1177/107755870005700405 11105514

17. Weilburg JB, O'Leary KM, Meigs JB, Hennen J, Stafford RS. Evaluation of the adequacy of outpatient antidepressant treatment. Psychiatric Services. 2003;54(9):1233–9. doi: 10.1176/ 12954939

18. Melfi CA, Chawla AJ, Croghan TW, Hanna MP, Kennedy S, Sredl K. The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Archives of general psychiatry. 1998;55(12):1128–32. doi: 10.1001/archpsyc.55.12.1128 9862557

19. Kim K-H, Lee S-M, Paik J-W, Kim N-S. The effects of continuous antidepressant treatment during the first 6 months on relapse or recurrence of depression. Journal of affective disorders. 2011;132(1–2):121–9. doi: 10.1016/j.jad.2011.02.016 21402412

20. Sood N, Treglia M, Obenchain RL, Dulisse B, Melfi CA, Croghan TW. Determinants of antidepressant treatment outcome. American Journal of Managed Care. 2000;6(12):1327–39. 11151810

21. Kim L, Kim J-A, Kim S. A guide for the utilization of health insurance review and assessment service national patient samples. Epidemiology and health. 2014;36.

22. Iosifescu DV, Nierenberg AA, Alpert JE, Smith M, Bitran S, Dording C, et al. The impact of medical comorbidity on acute treatment in major depressive disorder. Focus. 2005;160(1):2122–75.

23. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. 2005;62(6):617–27. doi: 10.1001/archpsyc.62.6.617 15939839

24. Melfi CA, Croghan TW. Use of claims data for research on treatment and outcomes of depression care. Medical care. 1999:AS77–AS80. doi: 10.1097/00005650-199904001-00010 10217395

25. Bae K-Y, Kim S-W, Kim J-M, Shin I-S, Yoon J-S, Jung S-W, et al. Antidepressant prescribing patterns in Korea: results from the clinical research center for depression study. Psychiatry investigation. 2011;8(3):234–44. doi: 10.4306/pi.2011.8.3.234 21994511

26. Donoghue J. Antidepressant use patterns in clinical practices: comparisons among tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta Psychiatrica Scandinavica. 2000;101:57–61.

27. Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. Journal of affective disorders. 2000;58(1):19–36. doi: 10.1016/s0165-0327(99)00092-0 10760555

28. MacGillivray S, Arroll B, Hatcher S, Ogston S, Reid I, Sullivan F, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. Bmj. 2003;326(7397):1014. doi: 10.1136/bmj.326.7397.1014 12742924

29. Mottram PG, Wilson K, Strobl JJ. Antidepressants for depressed elderly. Cochrane database of systematic reviews. 2006;(1).

30. Hwang JE, Song I, Lee E-K, Ha D, Shin J-Y. Prevalence and predictors of tricyclic antidepressant use among elderly Koreans in primary-care and specialty clinics. International journal of clinical pharmacology and therapeutics. 2018;56(5):224. doi: 10.5414/CP203157 29578393

31. Jackson JL, O’Malley PG, Tomkins G, Balden E, Santoro J, Kroenke K. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis1. The American journal of medicine. 2000;108(1):65–72. doi: 10.1016/s0002-9343(99)00299-5 11059442

32. Stahl SM. Antidepressants and somatic symptoms: therapeutic actions are expanding beyond affective spectrum disorders to functional somatic syndromes. The Journal of clinical psychiatry. 2003;64(7):724–6.

33. Briley M. Clinical experience with dual action antidepressants in different chronic pain syndromes. Human Psychopharmacology: Clinical and Experimental. 2004;19(S1):S21–S5.

34. Zimmerman FJ, Katon W. Socioeconomic status, depression disparities, and financial strain: what lies behind the income‐depression relationship? Health economics. 2005;14(12):1197–215. doi: 10.1002/hec.1011 15945040

35. Hudson CG. Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. American journal of Orthopsychiatry. 2005;75(1):3–18. doi: 10.1037/0002-9432.75.1.3 15709846

36. Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: a meta-analysis. American journal of epidemiology. 2003;157(2):98–112. 12522017

37. Ikin JF, Creamer MC, Sim MR, McKenzie DP. Comorbidity of PTSD and depression in Korean War veterans: prevalence, predictors, and impairment. Journal of Affective Disorders. 2010;125(1–3):279–86. doi: 10.1016/j.jad.2009.12.005 20071032

38. Helzer JE, Robins LN, Wish E, Hesselbrock M. Depression in Vietnam veterans and civilian controls. Am J Psychiatry. 1979;136(4B):526–9. 426137

39. Chan D, Cheadle AD, Reiber G, Unützer J, Chaney EF. Health care utilization and its costs for depressed veterans with and without comorbid PTSD symptoms. Psychiatric Services. 2009;60(12):1612–7. doi: 10.1176/ps.2009.60.12.1612 19952151

40. Burcusa SL, Iacono WG. Risk for recurrence in depression. Clinical psychology review. 2007;27(8):959–85. doi: 10.1016/j.cpr.2007.02.005 17448579

41. Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. American Journal of Psychiatry. 2005;162(9):1588–601. doi: 10.1176/appi.ajp.162.9.1588 16135616

42. Melartin TK, Rytsala HJ, Leskela US, Lestela-Mielonen PS, Sokero TP, Isometsa ET. Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. Journal of Clinical Psychiatry. 2004;65(6):810–9. doi: 10.4088/jcp.v65n0612 15291658

43. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of general psychiatry. 1994;51(1):8–19. doi: 10.1001/archpsyc.1994.03950010008002 8279933

44. Demyttenaere K. Compliance during treatment with antidepressants. Journal of affective disorders. 1997;43(1):27–39. doi: 10.1016/s0165-0327(96)00095-x 9127828

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