21 April 2011

Antidepressants may not improve all symptoms of depression

Even people who show a clear treatment response with antidepressant medications continue to experience symptoms like insomnia, sadness and decreased concentration.


Even people who show a clear treatment response with antidepressant medications continue to experience symptoms like insomnia, sadness and decreased concentration, researchers at UT Southwestern Medical Centre have found after analysing data from the largest study on the treatment of depression.

"Widely used antidepressant medications, while working overall, missed these symptoms. If patients have persistent residual symptoms, these individuals have a high probability of incomplete recovery," said Dr Shawn McClintock, assistant professor of psychiatry and lead author of the analysis available in the April print issue of the Journal of Clinical Psychopharmacology.

Symptoms of depression

UT Southwestern researchers tracked a wide range of symptoms of depression – including sadness, suicidal thoughts, and changes in sleep patterns, appetite/weight, concentration, outlook and energy/fatigue – at the start of the trial and at the end of the antidepressant treatment course.

Dr McClintock's research used data from the Sequenced Treatment Alternatives to Relieve Depression, or STAR*D study, the largest ever on the treatment of major depressive disorder and considered a benchmark in the field of depression research. The six-year, National Institute of Mental Health-sponsored study initially included more than 4,000 patients with major depressive disorder from clinics across the country. Dr Madhukar Trivedi, professor of psychiatry at UT Southwestern, was co-principal investigator of STAR*D and an author on this paper that analyzed data.

All responders reported between three to 13 residual depressive symptoms, and 75% of participants reported five symptoms or more.


Some of their symptoms included insomnia that occurs in the middle of the night (nearly 79%); sadness (nearly 71%); and decreased concentration and decision-making skills (nearly 70%). Moderately severe midnoctural insomnia was reported in nearly 60% of participants – more than twice as frequently as other symptoms.

Thoughts of suicide rarely persisted or emerged during treatment, researchers found.

"Some people fear that antidepressant medication increases thoughts of suicide," Dr McClintock said. "This provided counterevidence of that."

Researchers in the STAR*D trial found that only 33% of people go into remission in the first 12 weeks of treatment with an antidepressant medication known as an SSRI, or selective serotonin reuptake inhibitor. Of the available antidepressant medications, SSRIs are the most commonly prescribed for the treatment of depression.

Individuals on SSRIs often still exhibit symptoms of depression. For one of first times, researchers sought with this analysis in a large sample to identify residual symptoms of the disease and whether these symptoms began before or during treatment.

The findings

Dr McClintock and colleagues looked at data from the 2,876 STAR*D participants who completed the first phase of the trial – treatment with an SSRI for 12 weeks. About 15% of those participants, or 428 people, responded to treatment with no remission. Response was defined as a 50% decrease in severity of depression. The average age of participants was 40, 73% were white, and 66% were female.

Each year about 19 million adults in America struggle with depression. People with depression are often at increased risk of heart disease, diabetes, asthma and obesity. Depression cost the US an estimated $83 billion a year.

The next step, Dr McClintock said, will be to develop more targeted antidepressant therapies to decrease depressive symptoms, and to understand better the association between depression and concentration.

Dr Trivedi said, "Our findings do suggest that the use of measurement-based care techniques to identify and target residual depressive symptoms is essential to help patients return to normal function and recover from depression in the long term." (EurekAlert/ April 2011)

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Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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