SSRI Maintenance Doesn't Prevent Recurring Depression
> 1/23/2008 12:35:10 PM

Chronically depressed patients who've recently emerged from a particularly low period but continue taking their antidepressant (AD) medications in order to pre-empt a recurrence are actually just as likely to fall back under the disorder's influence, according to new research.

Many individuals suffer from chronic, recurring depression that often moves in a wave-like pattern, with periods of relative stability lasting months or years before the disorder inevitably returns with renewed strength. These "relapses" may be related to personal circumstances but more often simply represent the patients' biological predispositions. Patients are particularly susceptible if their depressive periods last more than three months, if they began before the age of 25, or if the patients have experienced recurrence within two months of discontinuing medications in the past. The most common preventive strategy for depression is the continuation of AD medications - one assumes that, by keeping patients on their medications, the risk of future depressive periods will be downgraded or eliminated due to the constant presence of antidepressant pharmaceutical substances in their systems.

But despite contradictory earlier research concerning AD maintenance among the elderly, a new study implies that certain patients susceptible to mood disorders do not benefit from AD maintenance regimens taken during periods of euthymia (or balanced, non-depressive mood), and that such treatment plans do not significantly decrease the likelihood that they will revert to their previous state. While elderly AD patients reported increased sociability, lifestyle activity and general disposition while on SSRIs as opposed to strict placebo or personal therapy approaches, these trends seem to apply more directly to late-life depression. Another difference between the two studies was the fact that the elderly patients in the later study were notably depressed and not experiencing periods of emotional stability at the time of the study.

The most recent research involved 172 patients who were, at the time of the study, experiencing lulls in their recurrent states of depression. Researchers based the study on a notable trend among AD maintenance patients: many decide independently to stop taking their medications, a move most likely prompted by a sense of renewed strength allowing them to "beat" the disease but certainly not in keeping with their doctors' orders. In fact, a majority of the patients in this study group discontinued their medications, and most of them, of course, reported a return of depressive symptoms during the study's 2 year duration. But even among the 26% who continued to take their meds exactly as prescribed, a majority (60%) reverted to depressive states before study's end. Patients who took their medications sporadically had only slightly higher rates of recurrence (63%), implying that the preventive power of these SSRI medications is minor at best. In fact, the study's most positive results came for patients undergoing periods of brief cognitive therapy - an approach that has proven effective among patients with chronic conditions not spurred by individual life traumas. Therapy to compliment medication is crucial for patients who deal with the problem on a lifelong rather than periodic basis.

This is not to discount the power of antidepressants or dismiss their use entirely - they are essential parts of a successful treatment regimen for millions of affected patients, and those wishing to discontinue their antidepressants due to perceived symptomatic upturns should reconsider and proceed with caution, especially if they've experienced more than one depressive period in recent years. This study simply enumerates the fact that these medications, on their own, do not constitute a one-stop cure, especially when relating to depression that has yet to manifest itself. They seem to lose their efficacy once the body has become accustomed to their presence in much the same way that drinkers build up a greater degree of tolerance to alcohol over time. Victims of recurring depression understandably experience great relief as their symptoms recede, but just as they cannot attribute their recovery to pharmaceuticals alone, they should not take such developments as proof that they no longer need their medications. A combination of meds and therapy has repeatedly proven very effective in clinical trials, and all patients should be aware of this fact before they consider taking the course of their treament into their own hands.

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