Leveraging Data to Intervene Early in Treatment-Resistant Depression

EP: 1.Lower Costs, Better Outcomes: Managed Care Strategies for DM-BUP Adoption

EP: 2.From Data to Decisions: Enabling Early Adoption of Cost-Saving Depression Therapies

EP: 3.Reducing Costs for Alzheimer Disease With Better Tolerated Therapies

EP: 4.Leveraging Digital Monitoring for Major Depressive Disorder

EP: 5.Ensuring Timely Access to Next-Line Migraine Therapies

EP: 6.Multidisciplinary Approaches to Optimize Migraine Management

EP: 7.Cost-Effective Strategies for Depression Management at AMCP Nexus

EP: 8.Driving Adoption of Combination Therapies for Treatment-Resistant Depression

EP: 9.The Value of Safer Treatment for Alzheimer Agitation

EP: 10.Expediting Access to DM/BUP for Alzheimer Disease Agitation Management

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EP: 11.Leveraging Data to Intervene Early in Treatment-Resistant Depression

EP: 12.Distinguishing Treatment Resistance from Comorbidity Burden in Depression Care

Steven Stoner, PharmD, a board-certified psychiatric pharmacist and associate dean for student affairs at the University of Missouri–Kansas City, School of Pharmacy, discussed strategies for identifying patients likely to develop treatment-resistant depression (TRD) earlier, a critical step in preventing escalating health care costs.1

Stoner acknowledges that fully predicting TRD is impossible but suggests clinicians should look at risk factors such as family history, contributing environmental factors, and the patient's level of apathy or willingness to engage in treatment. He argues that if a therapy like dextromethorphan-bupropion (DM/BUP) demonstrates superior effectiveness in a TRD population, it logically supports using the product earlier to avoid TRD altogether.

Stoner stresses the importance of leveraging patient-reported outcomes and digital monitoring, noting that mental health professionals have historically "discounted" what patients report. He urges a better job of listening and validating patient experiences.

From a clinical and payer standpoint, Stoner outlines specific tools and monitoring approaches:

• Standardized Screening: Depression screening tools (like a PHQ-2 or PHQ-9) should be standard procedure in the ambulatory care setting. The resulting data must be entered and reviewed as part of the patient's visit.
• Digital Adherence Tracking: For prescription digital therapeutics or other devices, digital monitoring can track adherence. Tracking factors such as whether the patient is logging in, going more than three days without engaging, or spending an appropriate amount of time on the device can flag non-adherence early.
• Early Intervention: Flagging non-adherence allows for earlier intervention, such as a phone call. This compassionate, empathetic outreach helps build a trusting therapeutic alliance, which is crucial because, as Stoner notes, attention and empathy alone can lead to better outcomes (reflecting the high placebo response rates seen in studies).

Stoner firmly believes that early investment—ensuring adherence, strong follow-up, and patient engagement—yields significant benefits on the "backside," leading to fewer hospitalizations, reduced calls for acute care, and ultimately, lower costs.

Reference

1. Cutler AJ, Zhao Y, Zeni C, et al. Merative MarketScan cost analysis of patients treated with dextromethorphan-bupropion by treatment line. Presented at: AMCP Nexus; October 27-30, 2025; National Harbor, Maryland. Abstract. (Study 3)