First Antidepressant Fails 70% of Time
Study Seeks Best, Real-World Depression Treatment: Early Results In
Jan. 4, 2006 - Antidepressant medication, all by itself, puts depression
into remission for 30% of patients, a government-funded study shows.
What about the other 70% of people with depression? And how long must the
lucky 30% stay on medication? Stay tuned. The study is just starting to get
Unlike nearly every other study of antidepressant medications, this one is
funded by the National Institute of Mental Health (NIMH) -- not by the drug
industry. It doesn't just measure small improvements in carefully selected
people with depression. This study looks at real patients seeking help from
real-world psychiatrists and primary-care doctors. And it plans to continue
until nearly every patient fully recovers from depression.
"We have to increase our expectations from depression treatments,"
study co-leader Madhukar H. Trivedi, MD, tells WebMD. "We have to push for
full remission as an outcome, because falling short leads to less quality of
life, with worsening of symptoms over time."
The first results from the 4,000-patient study -- the STAR*D (Sequenced
Treatment Alternatives to Relieve Depression) study -- appear in the January
issue of the American Journal of Psychiatry.
NIMH Director Thomas R. Insel, MD, hails STAR*D as a landmark for depression
"Too many research studies have little immediate relevance to practice,
and too little practice is based on research evidence," Insel writes in an
editorial accompanying the study. "STAR*D [is] studying patients in
real-world settings and asking questions with practical relevance."
Married Patients Get Better Faster
In this first report, Trivedi and colleagues report on some 3,000 patients
who completed the first phase of the study. All patients first get 12 weeks of
treatment with Celexa, an SSRI antidepressant.
Why Celexa? Trivedi says it's not because they think Celexa is more
effective than other antidepressants. The researchers chose to start with
Celexa because SSRI antidepressants are the first choice of most U.S. doctors
and because of Celexa's chemistry. The drug stays in the body long enough to
avoid withdrawal symptoms if a patient misses a few doses, but it goes away
fast enough so that its effects won't be confused with those of the next drug
doctors may try.
In fact, Trivedi says, he thinks the results seen with Celexa should apply
to other modern antidepressant drugs.
Overall, about 30% of patients got full remission with Celexa treatment. But
it didn't happen overnight. Nearly all patients needed at least eight weeks of
treatment -- and a relatively high dose of Celexa -- before they got
"We find there is a time point in the first few weeks of depression
treatment when doctors and patients lose patience and the patient drops out of
treatment. The drop-out rate is huge," Trivedi says. "But if you go on
long enough, remission rates are higher. You may need more doctor visits than
people generally have when getting treated for their depression."