For Depression May Improve Outcomes - If First Medicine Does Not Work
Try or Add Another Medication - Study Says
Successfully treating depression may require trying different drugs,
according to research from the UT (University of Texas) Southwestern
Medical Center. They found that one in three to four people who do not
achieve a full remission of symptoms from an initial antidepressant
became symptom-free after changing to or adding a second antidepressant.
Dr. A. John Rush said “The message to the patient is: 'Hang in there. If
the first treatment does not relieve your symptoms, consider changing or
adding another medication. Follow instructions from your doctor, and
don't give up.” Rush is the vice chairman of clinical sciences and
professor of psychiatry at UT Southwestern Medical Center.
The $35 million six year study involved nearly 3,000 patients. The
researchers wanted to assess the effectiveness of various treatments for
depression in "real-world" settings for people who also have other
medical and psychiatric conditions. The study, designated STAR*D
(Sequenced Treatment Alternatives to Relieve Depression), was broken
down into four phases.
In the first phase the participants were treated with the antidepressant
citalopram hydrobromide (Celexa) for up to 14 weeks. A
"measurement-based care" approach was used to assess progress. The
patients were evaluated for symptoms and medication side effects at each
visit based on certain guidelines, with dosages modified as needed. The
researchers found that at the end of phase one, about one-third of the
participants were symptom-free.
In the second phase the patients were given a choice whether to add
another drug to Celexa or switch drugs. Of those, 1,429 continued in
the study. Those who chose to switch medications were randomized into
three groups receiving one of three popular antidepressants: bupropion
hydrochloride-SR (Wellbutrin-SR), sertraline hydrochloride (Zoloft) or
venlafaxine hydrochloride-XR (Effexor-XR). Of those, approximately 25
percent achieved remission of symptoms within 14 weeks. There was no
significant differences in efficacy, safety or tolerability between the
Participants who chose to add a medication were given either bupropion
hydrochloride-SR or buspirone hydrochloride, along with citalopram. Of
this group, 30 percent of these patients became symptom-free within 14
weeks. Interestingly, neither medication combination was statistically
different in its effectiveness on primary outcomes.
Dr. Madhukar Trivedi said "These results show that augmenting a first
antidepressant with a second one may be worthwhile for some patients and
might be considered even earlier for some people." Trivedi is professor
of psychiatry at UT Southwestern and lead author of one of the studies.
"If you add together the people who achieved remission in both phase one
and phase two of STAR*D, you see that more than 50 percent of
participants become symptom-free after one or two treatments. That is
exciting. If you compare this to the vast majority of other chronic
medical diseases, getting to remission in this large percentage is good
Dr. Rush said "The bottom line is, 'If you can hang in there for at
least two different treatments, you have better than a 50 percent chance
of not just getting better, but getting well'.” He added “The bad news
is that we still have a way to go with the 40 percent of people who've
had two different drug treatments and still haven't achieved remission –
which means that we need better treatments. For a person walking into a
doctor's office with depression, that could mean that your first
treatment may not be your last. But it does suggest that it's worthwhile
to keep on trying."
There are about 19 million adults struggling with depression each year.
That accounts for 9.5 percent of the total population. The episodes
frequently return and usually last two years. The researchers said
depression, the fourth-most disabling illness worldwide, cost the United
States an estimated $83 billion in the year 2000.
By Dan Wilson
Books on the Mind
Keywords and Misspellings: Anti-depressant anti-depresant
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