Healthy Skepticism Library item: 6338

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Publication type: news

Johnson A.
Study Looks at Resistance To Depression Treatment
The Wall Street Journal 2006 Nov 1
http://online.wsj.com/article/SB116234875653509763.html

Full text:

THE WALL STREET JOURNAL
Study Looks at Resistance To Depression Treatment
By AVERY JOHNSON
November 1, 2006; Page D9

A high-profile U.S. study on depression found that two-thirds of patients
achieve remission, if they stick with therapy. But those who needed more
than two treatments had sharply lower rates of success.

The study underscores the pervasive problems that psychiatrists face
treating the most difficult patients, who are resistant to many existing
treatments, and the need for more innovative antidepressants. It also
suggested that patients who don’t respond to one type of antidepressant can
still benefit from a different drug in the same class, and don’t immediately
need to be switched to a drug with a wholly different method of action.
Persisting in treatment was found to be key.

The study, parts of which already have been published, was seen as a
landmark, because it looked at depression treatment over a much longer
period of time than studies done by the companies that make the drugs. It’s
expected to help determine practice guidelines. An overview of the $35
million program, called Sequenced Treatment Alternatives to Relieve
Depression, or STAR*D, and funded by the National Institute of Mental
Health, is being published today in the American Journal of Psychiatry.

The study, run over seven years, wrapped up its tests last year and is now
producing a series of reports on its findings. In phases one and two,
released earlier this year, the study found that 36.8% of patients went into
remission after trying their first treatment, and that 30.6% of those
remaining found relief with their second treatment. But harder-to-treat
patients, who required third and fourth attempts, went into remission only
13.7% and 13% of the time, respectively. After 12 months, 71.1% of patients
who had tried four treatments had relapsed back into depression.

The study has been unique in its length and methods. It was conducted in a
real-world setting by following patients already seeing their doctors,
rather than paying patients to join a trial. It also set as its treatment
goal complete remission, rather than just a reduction in symptoms. The study
was the largest-ever treatment study of depression, with 4,041 depressed
patients enrolled at its highest point, but only 123 patients remained by
the fourth phase.

A. John Rush, who led the study at the University of Texas Southwestern
Medical Center at Dallas, called the findings a mix of good news and bad.
“It’s discouraging but not unanticipated. If you hit a home run with the
first and second treatments, the people that are left are much harder to
treat,” Dr. Rush said. “With treatment-resistant depression, the kinds of
treatments these people may need may be different than what we have right
now.”

Keris Myrick, a 45-year-old graduate student from Pasadena, Calif., suffers
from some of the problems common to treatment-resistant patients. She said
she has tried almost “everything,” from medicines that work like Zoloft to a
new antidepressant patch. “I’m investigating vagus-nerve stimulation, but
the only other option is to start back anew, and try a medicine we’ve tried
before at a different dose,” she said.

Write to Avery Johnson at avery.johnson@wsj.com