Investigating the Use of Antidepressants in Treating Major Depressive Disorder:

Objectives: To investigate patterns of antidepressant prescribing and continuation rates among patients with major depressive disorder (MDD) in Saudi Arabia and to identify factors associated with treatment persistence. Method: A retrospective study was conducted at King Fahad Hospital of the University between May 2023 and February 2025. Data on patients' demographic characteristics, diagnostic information, and prescribed medications were collected. Initial antidepressant therapy and treatment continuation were evaluated, and potential influencing factors were analyzed. Results: Selective serotonin reuptake inhibitors (SSRIs) accounted for most first-line prescriptions (71%), followed by SSRI/atypical combinations (11%) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (5%). Of the 220 patients assessed for treatment continuation, only 38% maintained their initial therapy beyond three months. Continuation was highest among those treated with SNRIs, either alone or in combination with atypical agents, while SSRIs had the lowest persistence rate (35%). Older age and higher BMI were also significantly associated with enhanced treatment adherence. Conclusion: Although SSRIs remain the predominant first line treatment for MDD in Saudi Arabia, their limited continuation rates highlight the need for alternative approaches. The comparatively higher persistence observed with SNRIs highlights their potential for long term management. These findings advocate for personalized antidepressant selection and adherence enhancing interventions, thereby improving outcomes in MDD. Future studies should investigate biological markers, such as alterations in BDNF expression, and adjunctive non-pharmacological approaches to better elucidate the variability in treatment outcomes among patients with MDD.