By Daniel DeNoon
Jan. 4, 2006 - Antidepressant medication, all by itself, puts depression into remission for 30% of patients, a government-funded study shows.
What about the other 70% of people with depression? And how long must the lucky 30% stay on medication? Stay tuned. The study is just starting to get interesting.
Unlike nearly every other study of antidepressant medications, this one is funded by the National Institute of Mental Health (NIMH) -- not by the drug industry. It doesn't just measure small improvements in carefully selected people with depression. This study looks at real patients seeking help from real-world psychiatrists and primary-care doctors. And it plans to continue until nearly every patient fully recovers from depression.
"We have to increase our expectations from depression treatments," study co-leader Madhukar H. Trivedi, MD, tells WebMD. "We have to push for full remission as an outcome, because falling short leads to less quality of life, with worsening of symptoms over time."
The first results from the 4,000-patient study -- the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study -- appear in the January issue of the American Journal of Psychiatry.
NIMH Director Thomas R. Insel, MD, hails STAR*D as a landmark for depression research.
"Too many research studies have little immediate relevance to practice, and too little practice is based on research evidence," Insel writes in an editorial accompanying the study. "STAR*D [is] studying patients in real-world settings and asking questions with practical relevance."
Married Patients Get Better Faster
In this first report, Trivedi and colleagues report on some 3,000 patients who completed the first phase of the study. All patients first get 12 weeks of treatment with Celexa, an SSRI antidepressant.
Why Celexa? Trivedi says it's not because they think Celexa is more effective than other antidepressants. The researchers chose to start with Celexa because SSRI antidepressants are the first choice of most U.S. doctors and because of Celexa's chemistry. The drug stays in the body long enough to avoid withdrawal symptoms if a patient misses a few doses, but it goes away fast enough so that its effects won't be confused with those of the next drug doctors may try.
In fact, Trivedi says, he thinks the results seen with Celexa should apply to other modern antidepressant drugs.
Overall, about 30% of patients got full remission with Celexa treatment. But it didn't happen overnight. Nearly all patients needed at least eight weeks of treatment -- and a relatively high dose of Celexa -- before they got better.
"We find there is a time point in the first few weeks of depression treatment when doctors and patients lose patience and the patient drops out of treatment. The drop-out rate is huge," Trivedi says. "But if you go on long enough, remission rates are higher. You may need more doctor visits than people generally have when getting treated for their depression."
The patients who got better tended to be white, female, better educated, with higher pay, and married. Being married seemed to be particularly helpful.
"Being in a marital relationship seems to produce better outcomes," Trivedi says. "It is hard to separate out better marital status from other factors such as being in a better socioeconomic group. But the finding is very interesting. It sounds like a meaningful marital relationship makes depression treatment work better."
"Maybe it is because the spouse offers the patient support," Trivedi suggests. "Maybe the spouse is encouraging the patient to stay with the treatment. Maybe the spouse is identifying things for the patient that the patient brought back to us and that let us tailor that individual's treatment much better. And there is the potential that these positive relationships may make the stressors in the patients' day-to-day lives a little shorter."
First Antidepressant Fails 70%
Because the patients are being seen in busy psychiatric clinics or primary-care centers, STAR*D patients first get antidepressant medication without psychotherapypsychotherapy. That may be part of the explanation for the 70% failure rate, says depression expert Andrew Elmore, PhD, a private-practice psychotherapist and assistant clinical professor at Mt. Sinai School of Medicine in New York.
"If you are running a race, you need food and training. Most people need drugs and therapy to treat their depression," Elmore tells WebMD. "In all the studies, the group that gets both goal-oriented psychotherapy and an effective drug does better than the group that gets either one alone."
But the bigger question, Insel notes, is what treatment do those 70% of depressed patients need now?
Finding Out What It Takes to Beat Depression
There's no answer to Insel's question -- today. That may change this summer, when findings from the second part of the STAR*D trial will be announced.
Part two of the study is much more complicated. Patients who don't get full remission of their depression will be offered the chance to switch to one or more different antidepressant drugs, add a new antidepressant drug, or switch to psychotherapy (with or without drug treatment).
"If you get to full remission with the first medication, you are better off because you don't have to go to the expense and time of trying more things," Trivedi says. "For those who don't get full remission, it is the same thing as with diabetes and arthritis and hypertension and other things -- you keep looking for something that works. But for those who finally get full remission, I think there is a profound payoff. Your symptoms are all gone, and you return to your previous level of function, and your long-term outcome is profoundly better than if you didn't get to remission."
When patients do get full remission, they enter a 12-month follow-up period. During this time, drug treatment continues.
Elmore argues that while these patients are getting successful treatment, it's too soon to say they are in full remission.
"Is it remission when they still have to take a drug?" Elmore asks. "My epilepsy is under control when I take phenobarbital every day. But if I still need the drug, my epilepsy is not in remission."
But Elmore praises the STAR*D trial for providing desperately needed real-world information. And whether it's called remission or successful treatment, Trivedi notes that patients badly need to get their depression under control.
"If patient symptoms have reduced to levels where they are virtually gone, that is remission," he says. "There may be some minor symptoms left, but their functioning is the same as you and I. And if you do achieve remission, your longer-term outcome is better than if we stop treatment before remission. A person not in remission is three times more likely to have a relapse in three to nine months."
Trivedi says one of the most important parts of the STAR*D trial is that all patients get evaluated for depression symptoms at every doctor visit.
"If you have high blood pressure, and nobody measures your blood pressure, how would you know to do anything different if your medication isn't working?" Trivedi says. "You have to measure symptoms on a regular basis. Patients can do this themselves. I personally would say psychotherapy patients should measure, too. Any treatment that actually is likely to be used for depression, we should regularly be measuring patient symptoms."
Doctors who aren't trained in psychotherapy may need to measure. But Elmore says trained therapists are capable of more sophisticated evaluations than multiple-choice questionnaires can provide.
"We measure progress by getting to know a patient well enough to know whether that person's situation has improved," he says. "I would think that the judicious therapist measures patient progress via means far more robust than paper-and-pencil tests. Therapy is not just giving advice. It is trying to understand whether the advice is helping the patient, and making the patient comfortable enough to know whether the therapy is helping or not. This can be done without subjecting a patient to a written exam."
IN THE WORKPLACE
New Research on Depression in the Workplace.
For more information please click here
To subscribe to SADAG's newsletter, click here
Mental Health Matters Journal for Psychiatrists & GP's
Click here for more info on articles & how to subscribe
Literacy is a luxury that many of us take for granted. We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local language, delivering critical information in an interactive, and educational way.
The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..
We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.
- Click here to see speaking books in action
- Click here for sample book on clinical trials
- Click here for latest press release 1.
- Click here for latest press release 2.
- Click here to connect to international site www.booksofhope.com
- Speaking books for Health Care YouTube
Preliminary Results on Depression Treatment
By Daniel DeNoon
Dr Reddy's Help Line
0800 21 22 23
Pharmadynamics Police &Trauma Line
0800 20 50 26
Adcock Ingram Depression and Anxiety Helpline
0800 70 80 90
Destiny Helpline for Youth & Students
0800 41 42 43
0800 55 44 33
Department of Social Development Substance Abuse Line 24hr helpline
0800 12 13 14
Suicide Crisis Line
0800 567 567
SADAG Mental Health Line
011 234 4837
Akeso Psychiatric Response Unit 24 Hour
0861 435 787
Cipla Mental Health Helpline
0800 456 789
MENTAL HEALTH CALENDAR 2018
Teen Suicide Prevention Week
11 - 18 February
Bipolar Awareness Day
Substance Abuse Awareness Day
Mental Health Awareness Month
1 – 31 July
Panic Awareness Day
World Suicide Prevention Day
World Mental Health Day
View our list of informative Infographs.
SADAG KZN Branch
SADAG have launched a new office in Durban with the support of Psychiatrist Dr Suvira Ramlall and Clinical Psychologist, Suntosh Pillay.
The offices are placed in St Joseph’s Hospital and are managed by Lyn Norton.
The KZN Branch is deeply committed to;
- Launching new Support Groups
- Workshops on aspects of Mental Health
- School Talks on Suicide Prevention
- Corporate Wellness For KZN companies
Please click here for more information about the KZN activities.
Want to become a volunteer counsellor? Contact Michelle/Christine 0800 21 22 23
Download Application Form Here
If you are interested in starting a Support Group, please contact Michelle on 0800 21 22 23.
To find a Support Group in your area, please phone SADAG on 0800 21 22 23.
If you are a journalist writing a story contact Cassey on
011 234 4837 /firstname.lastname@example.org