Meds

When one antidepressant doesn’t work, another may

Wed Apr 23, 2008 3:13pm EDT

NEW YORK (Reuters Health) – For people suffering from depression that doesn’t respond to treatment with one type of antidepressant, switching to a different type may be the best treatment, according to a new report.

Relatively new antidepressants such as Prozac and Zoloft, for example, are called selective serotonin reuptake inhibitors or SSRIs. In recent clinical trials, only about a third of depressed patients achieved remission with SSRI treatment, the authors explain, but there is little consensus among psychiatrists about the best treatment for patients when an SSRI doesn’t work.

To look into this, Dr. George I. Papakostas from Harvard Medical School, Boston, and his associates conducted an analysis of four clinical trials that compared a switch to a second SSRI versus a non-SSRI antidepressant for SSRI-resistant major depression.

The pooled data included 1496 patients who had not responded to treatment with one SSRI and were subsequently randomly assigned to treatment with another SSRI or a non-SSRI antidepressant.

Wed Apr 23, 2008 3:13pm EDT

NEW YORK (Reuters Health) – For people suffering from depression that doesn’t respond to treatment with one type of antidepressant, switching to a different type may be the best treatment, according to a new report.

Relatively new antidepressants such as Prozac and Zoloft, for example, are called selective serotonin reuptake inhibitors or SSRIs. In recent clinical trials, only about a third of depressed patients achieved remission with SSRI treatment, the authors explain, but there is little consensus among psychiatrists about the best treatment for patients when an SSRI doesn’t work.

To look into this, Dr. George I. Papakostas from Harvard Medical School, Boston, and his associates conducted an analysis of four clinical trials that compared a switch to a second SSRI versus a non-SSRI antidepressant for SSRI-resistant major depression.

The pooled data included 1496 patients who had not responded to treatment with one SSRI and were subsequently randomly assigned to treatment with another SSRI or a non-SSRI antidepressant.

Patients randomized to switch to a non-SSRI antidepressant were slightly more likely to experience remission than patients who were switched to a second SSRI, the researchers report in the medical journal Biological Psychiatry.

However, the non-SSRI antidepressants were somewhat less well tolerated than the SSRIs.

The results indicate that current treatments for depression are still less than ideal. “There continues to be a pressing need to introduce new antidepressant medications,” comments Dr. John Krystal, the journal’s editor.

SOURCE: Biological Psychiatry, April 1, 2008.

© Thomson Reuters 2008.
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Note from Forum Admin:

Not everyone with depression will respond to a particular antidepressant medication, but there’s a good chance that a second or third choice will be effective, researchers have found.

Dr. Frederic M. Quitkin and colleagues from Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, examined remission rates when patients who did not get better on one drug were switched to another, and then to a third if necessary.

The study, published in the Journal of Clinical Psychiatry, involved 171 patients treated with second-generation antidepressants and 420 patients treated with first-generation antidepressants.

Among the group treated with a second-generation antidepressant, 93 percent of those who stayed in the trial eventually achieved remission of their depression.

Among patients treated with a first-generation antidepressant, the remission rate was 96 percent.

“Our data suggest that correctly diagnosed depressed patients who receive 3 adequate trials of antidepressant medication have an approximately 90 percent chance of achieving a state of remission,” the authors conclude.

However, the team notes that altogether 111 participants dropped out of the studies.

“We could find no systematic analysis of why patients leave treatment,” the investigators say. “A major challenge is motivating depressed patients to continue treatment.”

SOURCE: Journal of Clinical Psychiatry, June 2005.

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