1st Antidepressant Has 1-In-3 Success Rate, Study Says

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1st Antidepressant Has 1-In-3 Success Rate, Study Says

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By LAURAN NEERGAARD The Associated Press

Published: Jan 1, 2006

WASHINGTON - A third of people suffering serious depression recover

with the first antidepressant they try, and well-educated white women

are most likely to benefit, according to initial results of an eagerly

awaited study on the controversial drugs.

*******One key finding: Patients whose depression symptoms disappeared

took higher than typical drug doses and received close monitoring and

frequent dose adjustments in the first three months, a level of care

few U.S. patients receive.******

The main goal of the government-funded study is to identify what

harder-to-treat patients should try when initial treatment fails,

instead of abandoning therapy in frustration. Those results are due in

a few months.

Psychiatrists long have known that for most depression sufferers, the

first antidepressant choice won't be a panacea, just as patients with

epilepsy, heart disease or cancer often must mix and match medications

before finding the best choice.

Unlike those illnesses, physicians have had little scientific evidence

to guide their choices of myriad antidepressants or how to maximize

each patient's chances of benefit.

To do that, " tailor the treatment, " said Madhukar Trivedi of the

University of Texas Southwestern Medical Center, who reported first

results from the study today in The American Journal of Psychiatry.

Thorough Care Is Rare

The study created an easy-to-use rating system to assess depression

symptoms and report drug side effects. That rating system, posted on

the Web for any doctor to use, allowed patients' drug doses to be

adjusted every two to three weeks until they hit the right balance, or

it became clear that another therapy was needed.

It's rare that antidepressant users receive this so-called

measurement-based care, said Nakamura, deputy director of the

National Institute of Mental Health, which funded the $35 million

study.

" Many people, because they're not given follow-up, the medications

aren't adjusted ... do end up being frustrated, and any negative side

effects, any trouble with dosage levels, will cause them to end

treatment, " Nakamura said.

A bonus: The ratings led to closer physician monitoring, with five to

six visits during the critical first months of antidepressant use.

Antidepressants have become extremely controversial in recent years

because of evidence that they on rare occasions worsen suicidal

tendencies in children or teenagers. In 2004, the Food and Drug

Administration ordered strong warnings about the pediatric risk be put

on antidepressant labels, and began analyzing whether adults face a

similar risk.

Meanwhile, the FDA urges that antidepressant users of all ages be

closely watched for symptoms that might signal suicidal behavior

during the first weeks of therapy.

There were no suicides among the almost 3,000 patients in Trivedi's

study, known as Star-D.

Suicide Risks

A separate study also published in the psychiatry journal tracked more

than 65,000 people, mostly adults, who used antidepressants in a

10-year period and were insured by the Seattle-based Group Health

ative. The risk of a serious suicide attempt was highest in the

month before patients started antidepressants, and the risk of a

serious attempt or a completed suicide dropped in the weeks after

treatment began, the researchers, also funded by the National

Institute of Mental Health, concluded.

" This study lends us some very important information " about adults,

but " it doesn't, however, alter our ongoing concern about children, "

said Seligman, who heads the FDA's Office of Drug Safety.

Ten percent of men and a quarter of women will have depression some

time in their lives, and it often recurs. There are about 20

medications and a variety of talk-based therapies, but little evidence

to say who is most likely to benefit from which approach.

Until now, most research has consisted of industry-funded comparisons

of a single drug with a placebo, among patients not considered

difficult to treat.

The six-year Star-D study aims to fill that gap.

In step 1, all enrolled patients were given Celexa, part of a newer

class of antidepressants known as selective serotonin reuptake

inhibitors.

Researchers aren't endorsing Celexa, Trivedi stressed. Researchers

can't explain why white women, especially the well-educated, were most

likely to recover with initial treatment. Also more likely to benefit

were patients with fewer co-existing illnesses and less severe

depression.

Those who didn't become symptom-free were moved to step 2, assigned a

variety of different therapies to determine care for harder-to-treat

patients.

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