Treatment disparities for major depressive disorder: Implications for pharmacists

Objectives: To determine whether differences exist in overall antidepressant use and specific antidepressant drug class (selective serotonin reuptake inhibitor [SSRI]/serotonin norepinephrine reuptake inhibitor [SNRI] versus other) use among patients of different race/ethnicity groups (blacks and Hispanics compared with whites) with a diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 12-month major depressive disorder (MDD) and to discuss ways in which pharmacists can decrease the gap in treatment disparities. Design: Cross-sectional study. Setting: United States from February 2001 through April 2003. Participants: Respondents of the National Comorbidity Survey-Replication with DSM-IV 12-month MDD. Intervention: Not applicable. Main outcome measures: Previous 12-month overall antidepressant use and previous 12-month specific antidepressant drug class (SSRI/SNRI versus other) use. Results: For respondents who screened positive for 12-month MDD (n = 362.3), only 34% reported antidepressant use in the previous 12-month period. Blacks (17.5%) and Hispanics (21.8%) reported significantly (P < 0.0001) lower overall use of antidepressants in the unadjusted analysis compared with whites (37.6%). Although not statistically significant, odds ratios (ORs) indicated that blacks and Hispanics were 61% and 47% less likely to report use of antidepressants (OR = 0.39 [95% CI 0.20-0.77], P = 0.10, and 0.53 [0.31-0.91], P = 0.61, respectively). Conclusion: Among respondents with a diagnosis of MDD, race/ethnicity plays an important role in the use of antidepressants. The results of this study indicate a need for pharmacists to proactively interact and manage their patients' antidepressant therapy.