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Study: Patients Shouldn't Give Up on Banishing Depression

Posted on: Thursday, 23 March 2006, 06:00 CST

By Kathleen Fackelmann

People with depression who don't get relief after taking one medication should switch or add another antidepressant, a study reports today.

"If the first drug doesn't work, don't give up," says John Rush, a psychiatrist at the University of Texas Southwestern Medical Center and the study's principal investigator.

Rush and his colleagues found that about 50% of people with depression could banish the blues with antidepressants, but some had to go to another drug or a drug combination to get relief.

The findings hold out hope for an estimated 15 million to 17 million Americans who have depression -- especially those with a depression that doesn't go away.

"This is a devastating illness with enormous public health implications," says psychiatrist David Rubinow of the University of North Carolina-Chapel Hill.

Untreated depression contributes to more than 30,000 suicides in the USA each year and is the fourth-leading cause of disability, Rubinow says.

He wrote an editorial that accompanies the two articles describing the study results in today's New England Journal of Medicine.

But drugs aren't the only answer to depression, says Richard O'Connor, a therapist in private practice in New York and the author of two books on depression. O'Connor says a skilled therapist often can help people work through problems that can exacerbate or trigger a depression.

The National Institute of Mental Health, part of the National Institutes of Health, paid for the $35 million study, which was conducted at 41 primary care and psychiatric centers all over the USA.

In the first phase of this six-year study, patients, including those who had severe depression, were treated with a common antidepressant, Celexa, for up to 14 weeks. Patients who didn't get relief or who experienced too many side effects had the option of taking another common antidepressant or adding medications that combat depression in a different way.

In the first article, Rush and his colleagues report on results from 727 people who decided to switch from Celexa to one of three popular drugs that help fight depression: Zoloft, Effexor and Wellbutrin. About 25% of those people were free of any symptom of depression within 14 weeks of the switch, Rush says.

The study found no real differences between the drugs selected. Rubinow says that, in practice, this means that the doctor and patient might have to try several different kinds of drugs before they hit on one that works.

In the second article, the team reports on 565 people who decided to add on to their therapies. Those patients continued taking Celexa but also took either Wellbutrin or Buspar.

Within 14 weeks of getting the additional treatment, about 30% were symptom-free, Rush says.

Symptoms of depression include persistent sadness, fatigue, lack of interest in usually enjoyable activities and feelings of hopelessness.

It's important to keep pushing for relief with drugs -- or talk therapy -- or both, says Peter Kramer, a psychiatrist at Brown University in Providence and the author of the book Listening to Prozac.

"It's risky to let depression last a long time," he says.

(c) Copyright 2005 USA TODAY, a division of Gannett Co. Inc.

Source: USA TODAY

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