- The Washington Times - Sunday, January 1, 2006


A third of people with serious depression recover with the first antidepressant they try, and well-educated white women are most likely to benefit, according to initial results of an eagerly awaited study on the controversial drugs.

One key finding: Patients whose depression symptoms disappeared took higher than typical drug doses and received close monitoring and frequent dose adjustments in the first three months — a level of care that few U.S. patients today receive.

The main goal of the government-funded study is to identify what harder-to-treat patients should try when initial treatment fails, instead of abandoning therapy in frustration. Those results are due in a few months.

Psychiatrists have long known that for most depression patients, the first antidepressant choice won’t be a panacea, just as patients with epilepsy, heart disease or cancer often must mix and match medications before finding the best choice.

But unlike those illnesses, physicians have had little scientific evidence until now to guide their choices of myriad antidepressants — or how to maximize each patient’s chances of benefit.

To do that, “tailor the treatment,” stressed Dr. Madhukar Trivedi of the University of Texas Southwestern Medical Center, who reported first results from the study yesterday in the American Journal of Psychiatry.

The study created an easy-to-use rating system to quickly assess depression symptoms and report drug side effects. That rating system — now posted on a Web site for any doctor to use — allowed patients’ drug doses to be adjusted every two to three weeks until they hit the right balance or it became clear that some other therapy was needed.

It’s rare today that antidepressant users receive this so-called measurement-based care, said Richard Nakamura, deputy director of the National Institute of Mental Health, which funded the $35 million study.

“Many people, because they’re not given follow-up, the medications aren’t adjusted … do end up being frustrated, and any negative side effects, any trouble with dosage levels, will cause them to end treatment,” Mr. Nakamura said.

However, the ratings system led to closer physician monitoring, with five to six visits during the critical first months of antidepressant use.

Antidepressants have proved controversial in recent years because of evidence that they on rare occasions worsen suicidal tendencies in children or teenagers. In 2004, the Food and Drug Administration ordered strong warnings about the pediatric risk be put on antidepressant labels and began analyzing whether adults face a similar risk.

Meanwhile, FDA urges that antidepressant users of all ages be closely watched for agitation of other symptoms that might signal suicidal behavior during the first weeks of therapy.

There were no suicides among the almost 3,000 patients in Dr. Trivedi’s study, known as STAR-D.

A separate study also published in the psychiatry journal said the risk of a serious suicide attempt is highest in the month before patients start antidepressants, and the risk of a serious attempt or a completed suicide dropped in the weeks after treatment began.

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