Drugs Work for Depression About Half the Time, Says Study

The results of the study, to appear in the New England Journal of Medicine, are being widely reported via PsycPort and elsewhere:

Significant numbers of patients continue to experience symptoms such as sadness, low energy and hopelessness after intensive treatment, even as about an equal number report an end to such problems — a result that quickly lent itself to interpretations that the glass was either half empty or half full.

The $35 million taxpayer-funded study was the largest trial of its kind ever conducted. It provided what industry-sponsored trials have rarely captured: Rather than merely ask whether patients are getting better, the study asked what patients most care about — whether depression can be made to disappear altogether.

Unusually, this study included patients more representative of the clinical norm than typical pharmaceutical industry clinical trials. By including patients with various comorbidities (other psychiatric or medical conditions), the study sheds light on the types of patients most often seen in the ‘real world’:

The study is immediately relevant to physicians because it tracked a large number of patients with the kind of complications and chronic problems that are usually excluded from pharmaceutical industry trials. About one in three patients had seen their depression symptoms go away after an initial round of treatment, a result known as remission. About half achieved that goal after a new round of treatment involving either a new medication or an additional drug, the research found.

However, the study was actually not quite ‘real world’, in the sense that the participants in the study received the best possible care, exceeding what is normally available in most medical practices:

At the same time, the researchers acknowledged, the care provided in the study was exceptional. Intensive monitoring and careful evaluation was provided to all patients. Such services are available today in perhaps one in 10 medical practices. If the patients in this study had received the kind of care that patients receive on average, the researchers said, the remission rate probably would have been significantly lower — perhaps even in the single digits.

Even so:

Augustus John Rush, a psychiatrist at the University of Texas Southwestern Medical Center in Dallas, who helped organize the study known as the Sequenced Treatment Alternatives to Relieve Depression, said the results are positive, given the many complications that often accompany depression.

In any case, this study appears to be the most robust ever conducted into (almost) ‘real world’ treatment of major depression by psychopharmacological means — and it shows that under the best possible circumstances, drugs have about a 50% chance of working. And while pharmaceutical companies might like you to believe that their own preferred product is just what you need, the drugs used in the study — Celexa, Wellbutrin, Zoloft and Effexor — all turned out to have roughly the same effectiveness.

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