Do Antidepressants Really Deliver?

I suppose the answer to this question hinges on the definition of deliver. Let’s start up top with the bottom line: Treating depression pharmacologically is not easy!

A major study, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) is the largest independently funded clinical trial for depression. The study’s primary objective was to develop a series of evidence-based steps for guiding prescribers in making sequenced treatment choices to enhance the odds of response rates and subsequent remission. The six-year study included approximately 3,000 clients. Initial results indicated that about 30 percent of depressed clients achieve remission (that is, their symptoms essentially disappeared) on their first antidepressant trial with competent care. Subsequent trials yielded a total remission rate of approximately 60 percent. After achieving full remission though, relapse rates are high: Only 43 percent of subjects realized sustainable recovery. Also, with quality care as a given, there is no difference in outcome whether the client was treated by a psychiatrist or a primary care physician.

At least 50 percent of clients who will respond (the rate of patients that experience at least a 50 percent reduction in the severity of symptoms) to antidepressants begin to demonstrate improvement within the first few days to a week of treatment, achieving symptom remission however, may span over an 8- to 12-week period. Achieving remission is important because clients that improve, but continue to have residual symptoms, are twice as likely to relapse to depression and are at an increased risk of suicide.

Since 2002, the only new antidepressants making it to market are Lexapro, Cymbalta, Emsam transdermal and Pristiq – an active metabolite of Effexor. Effexor is no longer under patent protection.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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