It may take time for antidepressants to work
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In a large, “real world” study of the antidepressant Celexa (citalopram), approximately half of depressed patients responded to treatment, investigators report. In many cases, however, at least 8 weeks of treatment was required for a response, even with periodic increases in the dose of the drug.
“These results highlight the need for longer treatment duration and more vigorous medication dosing than is current practice in order to achieve optimal remission rates,” lead investigator Dr. A. John Rush from the University of Texas Southwestern Medical Center at Dallas and colleagues conclude in the American Journal of Psychiatry.
Included in the so-called Sequenced Treatment Alternatives to Relieve Depression, or STAR*D trial, were 2876 patients with major depression seeking medical care in routine medical or psychiatric outpatient clinics.
Celexa was chosen as a “prototype” of the newer types of antidepressants called selective serotonin reuptake inhibitors or SSRIs.
Using what the authors call a “measure-based care approach,” treatment was started at 20 mg/day. Based on ratings of side effects and symptoms by the 16-item Quick Inventory of Depressive Symptomatology self-report (QIDS-SR), doses could be escalated to 40 mg/day by week 4 and to 60 mg/day by week 6.
During the 12-week trial, the overall remission rate was 27.5 percent according to Hamilton Depression Rating Scale and 32.9 percent for the QIDS-SR. Response rate according to the QIDS-SR (at least 50 percent reduction in baseline score) was 47 percent.
Of the participants who responded to treatment, 56 percent did so only at or after 8 weeks of treatment.
Patients with lower depression severity at baseline were more likely to achieve remission with therapy. Being white, female, better educated, with a good income, and living with someone as opposed to alone were also predictive of treatment success.
SOURCE: American Journal of Psychiatry January 2006.
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