In the long and frustrating battle against depression, persistence does pay.
A major government study reports today that at least a quarter of clinically depressed patients who failed to achieve a complete remission with one antidepressant succeeded by adding a drug or by switching drugs.
Overall, about half of the nearly 1,500 patients achieved remission -- the virtual absence of symptoms -- by completing two treatment steps, and at least a quarter more showed improvement.
The six-year, $35-million study is intended to provide the first scientifically based roadmap for treating depression.
Since the introduction of powerful antidepressants in the late 1980s, most treatment "has been driven by anecdotes -- small series of case reports, 10 patients helped by one combination, 15 by another," said Dr. Andrew Leuchter of UCLA, who helped conduct the study.
"This is the largest study ever to look at what is the best next step if you don't get well in the first step" of treatment, he said.
The study, sponsored by the National Institute of Mental Health, is the first part of a series of studies designed to formalize the procedures for a therapy that until now has largely relied on a doctor's intuition and experience.
"They are trying to find some science for what is now an art," said Dr. Jan A. Fawcett of the University of New Mexico, a spokesman for the mental health advocacy group NARSAD.
The study addressed one of the biggest problems with antidepressants: Many patients give up if they don't respond quickly to the first drug they try or if they suffer unpleasant side effects.
The study showed that results often took six to 12 weeks, much longer than expected.
The message to patients and physicians is "Hang in there," said Dr. A. John Rush of the University of Texas Southwestern Medical Center, who led the trials, which are reported today in the New England Journal of Medicine.
"For the depressed person, it may not matter so much what drug is being prescribed, but that the person moves forward and keeps trying," he said.
Depression affects nearly 15 million Americans each year and is the leading cause of disability between the ages of 15 and 44.
It is "an utter sense of hopelessness," said Dr. Thomas R. Insel, director of the National Institute of Mental Health. "Just getting up out of bed and going to work or to school become insurmountable challenges."
