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I wanted to remind folks who suffer from treatment-resistant depression of the success rate as reported in the Johns Hopkins White Papers:
If you’re on an antidepressant and it’s not working, don’t give up on it: You may need a higher dose, a longer duration of therapy, a different drug altogether, or a combination of medications. That’s the important lesson to learn from a large, six-year, four-step government study called the Sequenced Treatment Alternatives to Relieve Depression trial, or STAR*D. In fact, the researchers found that systematically trying these treatment options can lead to a remission in symptoms in up to half of severely depressed, treatment-resistant patients.
The study, which looked at the use of popular antidepressants in people with chronic depression (lasting, in some cases, 15-16 years), is the first to provide ‘real world’ scientific data on what to do when someone doesn’t respond to a particular drug, has severe depression, or suffers from multiple mental and physical ailments. These types of treatment-resistant patients are not typically included in antidepressants drug trials sponsored by pharmaceutical companies (which is probably why I never heard about it from most of my doctors, especially doctor number three, who aspired to be Lilly’s primary shareholder).
Take-Home Messages from STAR*D:
• One antidepressant treatment does not fit all. You may need to try several medications to find a drug regimen that works for you. What fits one person may not fit your particular biology.
• Persevering through several different treatment attempts, as arduous as that may be, can improve results for many people.
• At standard doses of the most commonly used class of antidepressants–selective serotonin reuptake inhibitors (SSRIs)–30 percent of patients with severe depression achieve remission with the first medication prescribed.
• It often takes 12 weeks to achieve an adequate response to medication, not the standard four to eight weeks that most doctors and mental health specialists were previously using to guide decisions.
• If the first choice of medication does not provide adequate symptom relief, switching to a new drug is effective about 25 percent of the time.
• Switching from one SSRI to another is almost as effective as switching to a drug from another class.
• If the first choice of medication does not provide adequate symptom relief, adding a new drug while continuing to take the first medication is effective in about one-third of people.
• For people who don’t respond to first-line therapy with an SSRI, adding a second drug to the SSRI drug regimen appears to be slightly better than completely switching medications.
• For those who don’t respond to switching a new drug or adding a second drug, trying a third medication can still help about one in five people.
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Therese Borchard is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Subscribe to Beyond Blue, visit her website, or follow her on Twitter @thereseborchard.
Meet others on the journey in
Therese’s community group
Ask Therese to be your friend
Therese Borchard is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Subscribe to Beyond Blue, visit her website, or follow her on Twitter @thereseborchard.
posted October 19, 2011 at 6:08 pm
Don’t forget ketamine! It’s kind of like a chemical ECT without the possible memory loss.
posted October 20, 2011 at 8:36 am
I’m not sure why this is good news. This information is hardly new and you say 25% or 30% of people get relief. I’ve been on antidepressants for 17 yrs. & for the past 3-4 years, I have had no relief at all. This article to me is just “old” news that does nothing for people that are treatment resistant.
posted October 20, 2011 at 8:38 am
What do you when you have gone through all the combinations and therapies and ECT and after 50 some years you are desperate for some relief from the darkness And now at the age of 61..I’m experiencing more sensitivity to the side effects of medications. Nothing works and I’m so tired of this affliction haunting me every day and night. Sleep is the only time I’m not aware of this state of mind.
posted October 20, 2011 at 9:29 am
Hi Therese,
This is a good article. I like the bullet points; my concentration is not what it used to be since a little more than a month or so ago.
I think that a major impediment to relief for many of us is the idea of needing meds in the first place.
For some like me, it is having to cow to a PA who deems my life so insignificant she insists on my coming in for evaluation when SHE wants me to, and will not work with me on another time. My sister-in-law says this has happened to my niece for her asthma meds. Can you imagine that? Good grief! (Those who require power will never have it…)
For others (and their caregivers, even – I have a few supporters like this), it may be simply the idea of chemical dependence.
So this article kind of had my eyes rolling back in my head a little bit. Well, my train (of thought) quickly departs, and I have to get to work anyway.
Ciao!
posted October 20, 2011 at 3:08 pm
I’m on a hefty dose of Effexor (300mg) and was still dealing with lack of energy. My doctor (I love this guy!) added Cytomel, a thyroid booster, to it and it has made a lot of difference! Rather than increase the dose of Effexor (I’m pretty much at the top) or add another anit-depressant, this was his call. I’m still within normal thyroid levels.
posted October 20, 2011 at 5:13 pm
I was on cymbalta 90mg. stopped working and now in a panic to find another medication to deal with this dreadful disease. i am starting to lose my grip. i am wondering if i need to see a neurologist. nothing is working. i have tried augmentation, combination, upping the dosage etc. has anyone ever tried tms?
posted October 21, 2011 at 12:44 am
The STAR*D trial was really big news for a while. It seems to be something that people do not discuss(professionals)as a red flag for concerned treatments. As much as 2/3rds of patients do not respond to initial treatment and those that do, still find it a constant struggle. A different thinking is that a lot of what is prescribed is the route of SNRIs and SSRIs as the popular treatments still does not get patients feeling better fast enough. However, if a patient has inadequate levels of folate, they may have low levels of the essential three neurotransmitters ( what the SNRIs and SSRIs use). Deplin is the first to market that is a TMM and helps to synthesize more of the three neurotransmitters. In fact, on the Deplin website, this is more information about studies that demonstrate adding Deplin has an impact in as little as 30 days, without raising side effects. Here are a couple of credible news articles on Deplin.
http://www.foxnews.com/health/2011/06/02/vitamin-that-fights-depression/
http://dailywd.womansday.com/health/daily-dose/2011/antidepressants/
posted May 9, 2012 at 5:44 pm
So, after trying all the major combos of medications, ECT with no success, 2 years of fealing worse than death, there is still no hope for any relief, these studys are a joke, talk about a waste of bloody time. Where do people like me go? Just waiting to die is hardly a fun or productive life. This just says the same old crap, bugger all people have much success & the rest of us are told not to give up. Good one.