Major depression often retreats only after patients have tried multiple drugs, and a large minority still have disabling symptoms even after using many medications, a landmark study suggests.
The good news from the federal study of 3,671 patients is that about two-thirds were depression-free after trying up to four different combinations of drugs or therapy.
Only 37 percent went into remission after trying the first drug, the antidepressant Celexa, says the study leader, psychiatrist A. John Rush of the University of Texas Southwestern Medical Center in Dallas.
And as each new treatment was tried, it worked on fewer and fewer patients. About a third did not go into remission, despite trying up to four rounds of treatments. And many dropped out at each step, perhaps because they were discouraged or disliked drug side effects.
"But persistence pays off," Rush says. "For those who hang in there, recovery is possible."
The study, reported this past week in the American Journal of Psychiatry, is the largest ever on treating depression and the first to look at what happens when adults not helped by one drug are given others and/or therapy, Rush says.
Some patients received cognitive therapy, a structured type of counseling, either alone or in combination with a drug. No single treatment relieved depression better than any other.
Patients were followed for up to a year. Those who had to try more than one drug were most likely to relapse.
The study adds to growing evidence that major depression is a chronic disease, says John Greden, executive director of the University of Michigan Depression Center in Ann Arbor. Patients must be treated aggressively and closely monitored, he says.
Real-world success in treating depression may be considerably less than in the research, Greden says, because primary-care doctors write about 70 percent of prescriptions for antidepressants, and they're less likely to try multiple treatment steps.
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