Patterns of antidepressant persistence in mood and anxiety disorders: a retrospective population-based cohort study.
9 affiliations
- 1College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Apotex Centre, Office 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
- 2Children's Hospital of Research Institute of Manitoba, Winnipeg, MB, Canada.
- 3Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- 4Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- 5Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- 6Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada.
- 7College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Apotex Centre, Office 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada. [email protected].
- 8Children's Hospital of Research Institute of Manitoba, Winnipeg, MB, Canada. [email protected].
- 9Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. [email protected].
Abstract
Background
Controlled studies and practice guidelines encourage antidepressant treatment to be continued for at least 6 to 12 months after symptom remission to reduce the risk of relapses. We aimed to assess the real-world persistence of prescribed antidepressants and identify factors affecting long-term persistence.Methods
This retrospective cohort study used outpatient prescription dispensing data from 2015 to 2021. The baseline and follow-up periods were set as 12 months before and after the index date, respectively. Administrative health data for this were obtained from the Population Health Research Data Repository at the Manitoba Centre for Health Policy in Manitoba, Canada. Individuals covered by the Manitoba Health Insurance Registry who initiated an antidepressant prescription and had a diagnosis of mood and anxiety disorders were included. The proportion of individuals who persisted on their first antidepressant prescription was determined at 3, 6, 9, and 12 months, and the odds of persistence were determined using multivariable logistic regression models.Results
Among 76,200 new antidepressant users (63.3% female), 30.2% of individuals filled their first antidepressant prescription only once, and 75.4% of users discontinued within 1 year. The proportion of individuals who persisted with their initial antidepressants declined over 3, 6, 9, and 12 months (56%, 41%, 33%, and 25%, respectively). Adjusted analyses identified several predictors of lower persistence at 12 months, including male sex (vs. female: OR 0.87, 95% CI 0.84-0.90), younger age (< 25 years vs. 25-65 years: OR 0.74, 95% CI 0.71-0.77), receipt of income assistance (vs. no assistance: OR 0.57, 95% CI 0.53-0.61), receiving tricyclic antidepressants (vs. receiving SSRIs: OR 0.31, 95% CI 0.28-0.34), concurrent benzodiazepine use (vs. non-use: OR 0.88, 95% CI 0.84-0.91), prior PTSD diagnosis (vs. no PTSD: OR 0.83, 95% CI 0.76-0.91), and mood and anxiety-related ambulatory visits (vs. no visits: OR 0.92, 95% CI 0.88-0.95).Conclusions
Antidepressant persistence among individuals with mood and anxiety disorders declined over time after the initial prescription and varied by demographic, clinical, and healthcare utilization factors. These findings underscore the need to identify individuals at higher risk of discontinuation and support further research to inform clinical and health system strategies to improve persistence.Clinical trial number
Not applicable.
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BibTeX
@article{aziz2026patterns,
title = {{Patterns of antidepressant persistence in mood and anxiety disorders: a retrospective population-based cohort study.}},
author = {Md Abdul Aziz and Abdullah Al Maruf and James M Bolton and Kaarina Kowalec and Sherif Eltonsy and Kevin Friesen and Christine Leong},
journal = {BMC psychiatry},
year = {2026},
month = aug,
doi = {10.1186/s12888-026-08482-3},
url = {https://europepmc.org/article/MED/42963749},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Patterns of antidepressant persistence in mood and anxiety disorders: a retrospective population-based cohort study.
AU - Md Abdul Aziz
AU - Abdullah Al Maruf
AU - James M Bolton
AU - Kaarina Kowalec
AU - Sherif Eltonsy
AU - Kevin Friesen
AU - Christine Leong
PY - 2026
DA - 2026/08/03
JO - BMC psychiatry
DO - 10.1186/s12888-026-08482-3
UR - https://europepmc.org/article/MED/42963749
AB - Background Controlled studies and practice guidelines encourage antidepressant treatment to be continued for at least 6 to 12 months after symptom remission to reduce the risk of relapses. We aimed to assess the real-world persistence of prescribed antidepressants and identify factors affecting long-term persistence.Methods This retrospective cohort study used outpatient prescription dispensing data from 2015 to 2021. The baseline and follow-up periods were set as 12 months before and after the index date, respectively. Administrative health data for this were obtained from the Population Health Research Data Repository at the Manitoba Centre for Health Policy in Manitoba, Canada. Individuals covered by the Manitoba Health Insurance Registry who initiated an antidepressant prescription and had a diagnosis of mood and anxiety disorders were included. The proportion of individuals who persisted on their first antidepressant prescription was determined at 3, 6, 9, and 12 months, and the odds of persistence were determined using multivariable logistic regression models.Results Among 76,200 new antidepressant users (63.3% female), 30.2% of individuals filled their first antidepressant prescription only once, and 75.4% of users discontinued within 1 year. The proportion of individuals who persisted with their initial antidepressants declined over 3, 6, 9, and 12 months (56%, 41%, 33%, and 25%, respectively). Adjusted analyses identified several predictors of lower persistence at 12 months, including male sex (vs. female: OR 0.87, 95% CI 0.84-0.90), younger age (< 25 years vs. 25-65 years: OR 0.74, 95% CI 0.71-0.77), receipt of income assistance (vs. no assistance: OR 0.57, 95% CI 0.53-0.61), receiving tricyclic antidepressants (vs. receiving SSRIs: OR 0.31, 95% CI 0.28-0.34), concurrent benzodiazepine use (vs. non-use: OR 0.88, 95% CI 0.84-0.91), prior PTSD diagnosis (vs. no PTSD: OR 0.83, 95% CI 0.76-0.91), and mood and anxiety-related ambulatory visits (vs. no visits: OR 0.92, 95% CI 0.88-0.95).Conclusions Antidepressant persistence among individuals with mood and anxiety disorders declined over time after the initial prescription and varied by demographic, clinical, and healthcare utilization factors. These findings underscore the need to identify individuals at higher risk of discontinuation and support further research to inform clinical and health system strategies to improve persistence.Clinical trial number Not applicable.
SN - 1471-244X
ER -