Patterns of antidepressant treatment changes among adults with major depressive disorder in Northwest Ethiopia: a hospital-based cross-sectional study.

Abstract

Background: Major depressive disorder (MDD) is a prominent cause of worldwide disability, severely affecting quality of life in Ethiopia. Despite a significant prevalence of treatment-resistant depression, challenges in treatment adherence, and a high prevalence of adverse drug reactions, the studies in Ethiopia have limited data on antidepressant treatment changes.

Objectives: This research aims to identify patterns of antidepressant treatment changes, the reasons for treatment changes, and associated factors among patients with MDD in Ethiopia.

Design: A hospital-based cross-sectional study.

Methods: The present study was conducted at Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia, from June 01, 2025, to August 30, 2025. The data was entered, cleaned, and analyzed by using SPSS Version 27. The antidepressant side-effect checklist was used to classify adverse effects as mild, moderate, or severe. The Naranjo adverse drug reactions (ADRs) probability scale assessed antidepressant-related adverse drug reactions; non-adherence was evaluated using a self-reported tablet count tool. A multivariable logistic regression model was utilized to identify factors associated with antidepressant treatment changes. The significance level was set at a p-value of 0.05, with a 95% confidence interval (CI).

Results: Out of 220 respondents, 127 (57.7%) did not respond to their antidepressants, which impacted their ability to carry out daily responsibilities. Approximately one-third of participants (80, or 36.4%) had switched medications. More than half of the patients with MDD (114, or 51.82%) experienced ADRs related to antidepressants. The prevalence of non-adherence to medication was 54.6%; 95% CI: 48.6, 60.9. Antidepressant treatment change was significantly associated with having a history of relapse (AOR = 2.52, 95% CI: 1.28, 5.42) and a history of hospital admission (AOR = 2.35, 95% CI: 1.25, 7.59).

Conclusion: The management of MDD in Ethiopia faces challenges such as high non-adherence rates, significant ADRs, and limited access to alternative treatments. About 36.4% of patients underwent antidepressant treatment changes. A history of relapse and admission history were associated with antidepressant treatment changes. Future research should investigate longitudinal research to understand non-response and its impact on patient outcomes.