Patients who sense no relief from prescribed antidepressants need to be patient and consider trying alternate meds even as their chances of success decrease, according to a wide-scale federal study published in the November issue of the American Journal of Psychiatry. In one of the largest related projects to date, researchers began with 3,671 Americans suffering from major depression. All were medicated with Celexa, one of the most commonly prescribed SSRIs, and more than a third experienced significant remission while on the drug, but the 63% not satisfied by this initial treatment then shifted to alternate medications. As patients tried more drugs, they saw diminishing returns: 30.6% of those unhappy with Celexa reported success with a second medication, and those who moved on to a third or fourth treatment option reported success rates of 13.7% and 13%, respectively. The overall remission rate was near 67%, which is a very encouraging number, but those who move through multiple medications with no relief in sight may find it harder to hope for success.
Some patients are obviously less responsive to the drugs in question, but for those suffering from seemingly insurmountable depression, the failure of one or two trials need not serve as a sign of defeat. The possibility that other drugs may be more effective should encourage patients to consider alternate treatments, but the more drugs one tries without noticeable success, the less likely he or she is to acheive the desired results. These patients also predictably run a greater risk of future relapse:
40 percent of those who achieved remission on their first drug relapsed within a year. That rose to 55 percent of those who took two tries to succeed and 65 percent and 70 percent of those requiring three and four tries, respectively.
Of course, this study only considered the impact of controlled chemical agents, not accounting for important factors such as financial circumstances, personal relationships and participation in therapy regimens that can greatly influence levels of depression. The study also did not include a control group who received no medication, therefore leaving out the sizable percentage of patients who recover on their own. Further studies will focus on the counseling variable, which is often just as important as medication. The fact is that depression is an extremely complex affliction and that effective remedies vary widely from case to case. Some patients have to pass through multiple trials in order to determine the best methods of treatment, but their patience and persistence may ultimately be rewarded.
“It’s a sobering message when you get down to requiring three or four steps,” said the chief researcher, Dr. A. John Rush of the University of Texas Southwestern Medical Center in Dallas. “It says that follow-up is critical” to make sure that people stay on the drugs, he said.
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