Physician perspectives in the treatment of major depressive disorder, borderline personality disorder, and post-traumatic stress disorder

Objective This study aimed to assess physician perspectives on the treatment of major depressive disorder (MDD), borderline personality disorder (BPD), and post-traumatic stress disorder (PTSD), focusing on monitoring, management, and clinical trajectory, addressing challenges such as diagnostic procedures, disease burden, and varied treatment patterns that complicate patient journeys.

Methods: Physician surveys were conducted across three countries: United States (US), Germany, and France. Sixty psychiatrists from each country were invited to participate if they had at least three years of experience treating patients with MDD, BPD, or PTSD. The survey was provided electronically to eligible psychiatrists in 2023.

Results: Approximately 50 psychiatrists from each country participated. In MDD, reducing suicidal ideation and symptom severity is key. Patient-reported symptoms often differ from those used by physicians to confirm MDD diagnosis or trigger referrals. MDD diagnosis usually takes one visit (except in France) and can take 2-3 months from symptom onset. In PTSD diagnosis takes two visits, but confirmation may take 4-7 months. Treatments focus on reducing distress and improving coping abilities, with pharmacological treatment as the first approach. For BPD, German psychiatrists confirm diagnosis in two visits compared to three visits in US and France. US and German psychiatrists prefer psychotherapy for BPD, while French psychiatrists favor pharmacological treatment.

Conclusion: Globally, the biggest unmet need for these disorders is more effective treatments with fewer side effects. In this study side effects represent the largest treatment barrier in MDD and PTSD. For BPD patients, the major unmet need is approved pharmacological treatments.