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Guidelines provide recommendations for the treatment of MDD according to severity. Aim of this study was to assess real-life utilization of psychotropic drugs based on severity of MDD in psychiatric inpatients. Drug utilization data from the program \u201cDrug Safety in Psychiatry\u201d (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) were analyzed according to the severity of MDD. From 2001 to 2017, 43,868 psychiatric inpatients with MDD were treated in participating hospitals. Most patients were treated with\u2009\u2265\u20091 antidepressant drug (ADD; 85.8% of patients with moderate MDD, 89.8% of patients with severe MDD, and 87.9% of patients with psychotic MDD). More severely depressed patients were more often treated with selective serotonin\u2013norepinephrine reuptake inhibitors and mirtazapine and less often with selective serotonin reuptake inhibitors (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 each). Use of antipsychotic drugs (APDs), especially second-generation APDs, increased significantly with severity (37.0%, 47.9%, 84.1%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 each). APD\u2009+\u2009ADD was the most used combination (32.8%, 43.6%, 74.4%), followed by two ADDs (26.3%, 29.3%, 24.9%). Use of lithium was minimal (3.3%, 6.1% ,7.1%). The number of psychotropic drugs increased with severity of MDD\u2014patients with psychotic MDD had the highest utilization of psychotropic drugs (93.4%, 96.5%, 98.7%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). ADD monotherapy was observed to a lesser extent, even in patients with non-severe MDD (23.2%, 17.1%, 4.4%). Findings reveal substantial discrepancies between guideline recommendations and real-life drug utilization, indicating that guidelines may insufficiently consider clinical needs within the psychiatric inpatient setting.<\/jats:p>","DOI":"10.1007\/s00702-022-02504-6","type":"journal-article","created":{"date-parts":[[2022,5,7]],"date-time":"2022-05-07T05:02:35Z","timestamp":1651899755000},"page":"925-944","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Pharmacological treatment of major depressive disorder according to severity in psychiatric inpatients: results from the AMSP pharmacovigilance program from 2001\u20132017"],"prefix":"10.1007","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8678-7419","authenticated-orcid":false,"given":"Johanna","family":"Seifert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah B.","family":"Maier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabienne","family":"F\u00fchrmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Bleich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"St\u00fcbner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel","family":"Sieberer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xueqiong","family":"Bernegger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waldemar","family":"Greil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelius","family":"Sch\u00fcle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sermin","family":"Toto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renate","family":"Grohmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias A.","family":"Reinhard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,5,7]]},"reference":[{"issue":"2","key":"2504_CR1","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1124\/pr.117.014381","volume":"70","author":"T Atkin","year":"2018","unstructured":"Atkin T, Comai S, Gobbi G (2018) Drugs for insomnia beyond benzodiazepines: pharmacology, clinical applications, and discovery. 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HM participated in an educational event sponsored by Livanova. ST is a member of the advisory board for Otsuka and Janssen-Cilag and has received speaker\u00b4s honoraria from Janssen-Cilag, Lundbeck\/Otsuka, Recordati Pharma GmbH, and Servier. XB is currently working as Senior Manager for Takeda GmbH. All other authors state that they have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Data evaluation and analysis of the AMSP database have been approved by the Ethics Committee of the University of Munich and the Ethics Committee of the Hannover Medical School (Nr. 8100_BO_S_2018).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"AMSP data are collected and stored anonymously and therefore do not involve any risk for the participants. All methods were carried out in accordance with the Declaration of Helsinki.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}