Only one in three patients in the throes of a mind-numbing depression recovers completely after a 12-week drug treatment program, but add another medicine to their treatment or switch to a new drug and 50 percent of patients are back to their pre-depression selves.
The finding, published in the New England Journal of Medicine, offers hope for 15 million people a year with depression, many of whom don’t seek treatment at all or give up too early.
This study, commissioned by the National Institute of Mental Health to test the effectiveness of real-world treatments, offers a realistic look at what people can expect from antidepressants.
The message, according to NIMH director Dr. Thomas Insel, is that people with depression should remain in treatment for at least six to eight weeks. If symptoms don’t go away, patients should not stop treatment, but ask their doctor to switch medicines or add another one to the mix.
“Fifty percent is extraordinarily good given the nature of these illnesses,” added Dr. A. John Rush, a professor of psychiatry at University of Texas Southwestern Medical Center and lead investigator of the study. “Most people should expect two treatment attempts.”
Between 2001 and 2004, Rush and his colleagues enrolled 2,976 patients at 14 centers throughout the country in the study. Most had severe depression. The trial, called STAR-D, was designed to follow patients through two to three rounds of treatment and assess who gets better. In the first round of treatment, a third recovered completely.
Those with lingering symptoms were then given a second drug or switched to another antidepressant and followed for an additional three months. By this second stage, more than half were still in the study. Another 20 percent totally recovered. The study is ongoing.
“The challenge is to come up with new treatments so we can do for depression what we do for hypertension,” Insel said. “One size doesn’t fit all.”
In another study using the same STAR-D patients, Myrna M. Weissman, a depression researcher at New York State Psychiatric Institute and Columbia University Medical Center, conducted psychiatric evaluations on 151 children living with depressed mothers. Weissman and colleagues found higher than expected rates of depression among the children. They also found that a mother’s recovery reduced the risk for depression in her children.
On average, the children were 12 and the mothers in their late 30s. Mothers had struggled with depression since their early 20s – with about six previous bouts of depression. About 72 percent were severely depressed.
According to Weissman, a third of their children carried their own psychiatric diagnosis, often depression or anxiety. Normally, about 8 percent of young people each year show signs of these problems.
The findings are published in the latest Journal of the American Medical Association.
“Reducing stress associated with a mother’s depression may reverse the long-standing symptoms in children who are likely to be genetically vulnerable,” Weissman said. “If you could delay the onset, you may be able to prevent it.”
Those interested in volunteering for a new sibling and depression study should visit Weissman’s research Web site, www.DepressionGenetics.org.
Newsday