A Review of Antidepressants Concludes That
Patients Just Aren’t Getting the Dose They Need

New York, NY—October 28, 2005—Your antidepressant may be more effective than you think. Though the most effective treatment for moderately severe depression, many patients often receive a treatment regimen that fails to alleviate their symptoms sufficiently. There is a great opportunity to rethink the issue of treatment, according to a review by Dr. John Mann, Director of the Department of Neuroscience at the New York State Psychiatric Institute at Columbia University Medical Center. The review, (The Medical Management of Depression) appears in the October 27 issue of the New England Journal of Medicine.

Currently, the most common treatment for major depression is the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), which, among them, have little difference in their effectiveness rate. However, 30 to 50 percent of patients do not improve appreciably or for very long - most likely because the drugs have not been properly administered in terms of dosage or length of time given or because adjunctive therapies have not been offered.

For instance, SSRIs do provide patients with relief but clinicians and patients often fail to stay the course in helping patients maintain the required duration of treatment necessary to experience substantial improvement. For recurrent depression, Dr. Mann writes “Maintenance treatment for 12 to 36 months reduces the risk of recurrence by two thirds.” Improving the patient’s outcome, particularly when he/she presents with a dual diagnosis of depression and bipolar disorder, requires that the treatment plan include the education of both patients and their families who may have unrealistic expectations about treatment. The length of treatment necessary before a patient with major depression experiences significant improvement is six to 10 weeks. The odds for improvement are increased when psychotherapy is added to the medication.

Regular monitoring is important and patients may not respond to the first treatment applied. One of the most frustrating things about treating depression is the less than desirable response rate. Patients who do not show substantial improvement require a change in dose or medication. Medication non-response is especially frustrating but not the end of the line. Electroconvulsive therapy (ECT) is effective for many, but it has a high relapse rate and antidepressant therapy is needed to maintain remission.

In Dr. Mann’s view, physicians should not be satisfied with partial improvement but should strive fro remission or substantial improvement. Future research should look to developing antidepressants that act more quickly than those currently available and that can produce lasting improvement so that they do not require continuation and maintenance treatment.

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