Many depressed patients who didn't get better on one medicine were able to overcome their crushing dark spells with another, according to the largest study ever of treatments for America's top mental health problem.
"The goal here was to find treatments that help people to get well, not just better," said Dr. Thomas Insel, director of the National Institute of Mental Health. "We have safe and effective treatments."
Up to one-third of those who added or changed medicines recovered. When viewed with earlier results, the new findings mean that roughly half the people who suffer from serious, long-term depression can get over it -- not just improve their symptoms -- with adequate medication.
Clear Message: Don't Give Up
His agency paid for the $35 million study, which involved thousands of people across the United States and has been widely praised as a real-world test of popular drugs that have received only limited testing until now.
The study found little difference among the five drugs tested -- Celexa, Zoloft, Wellbutrin, Effexor and Buspar -- and wasn't designed to compare them. All proved similarly effective and relatively safe. The clear message, doctors said, was that antidepressants should be given a six- to 12-week chance to work and that if one doesn't help, another should be tried.
"It's important not to give up if the first treatment doesn't work fully," or causes side effects, said one study leader, Dr. John Rush of the University of Texas Southwestern Medical Center in Dallas. Almost as many people were helped the second time around as the first, he said.
Two reports from the study were published today in the New England Journal of Medicine.
Remission vs. Cure
About 15 million Americans each year suffer depression, and it is the leading cause of disability in people ages 15 to 44. It often recurs, and doctors sometimes talk of it as an emotional cancer that, rather than cured, is put "in remission" with successful treatment.
Nearly two dozen antidepressants are on the market -- 189 million prescriptions were filled last year alone -- but they are controversial. Evidence on their effectiveness is limited, and the government recently ordered stronger warnings that some can worsen suicidal tendencies in teenagers in rare cases. The risk in adults is still being studied.
The big federal study first tested Forest Laboratories' Celexa, a newer type of antidepressant called a selective serotonin reuptake inhibitor, or SSRI, mostly because it's an easy-to-take daily pill.
One-third of the roughly 3,000 taking it recovered, though they generally took higher doses and were monitored more closely than most patients, researchers reported several months ago.