Depression Health Center

First Antidepressant Fails 70% of Time

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 interesting.

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 research.

"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 better.

"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."