Many Fail to Recover with Depression Treatment
Mon May 31, 2004
by Amy Norton

NEW YORK (Reuters Health) - Many people who receive standard therapy for depression still suffer from the condition up to two years after starting treatment, a new study suggests.

The study, which involved more than 1,200 patients diagnosed with depression at 46 U.S. primary care centers, found that nearly half of those who received "at least minimally appropriate" depression treatment did not improve.

Minimally appropriate care meant that over a six-month period, patients had at least four therapy sessions or spent two months or more on antidepressants. Of patients in the study, 542 received at least this level of care; however, 261 of them failed to recover after two rounds of minimally appropriate treatment.

The findings show that despite the availability of therapies that have been proven effective, there remains a group of patients with particularly hard-to-treat depression, according to Dr. Catherine Sherbourne of the research organization RAND Corporation in Santa Monica, California.

"What we need is more research on the most effective way to treat this group," Sherbourne told Reuters Health.

She and her colleagues report their findings in the journal General Hospital Psychiatry.

While fewer than half of all patients in the study received what the researchers deemed minimally adequate care, lack of trying does not seem to explain the nearly 50-percent rate of non-response among patients who did get this level of care.

According to Sherbourne's team, patients with persistent depression appeared to be receiving more-aggressive treatment -- with, for example, 15 percent being prescribed both drugs and therapy during each of the three six-month periods the study assessed. That compares with only three percent of patients who did respond to treatment.

It seems, the researchers write, that patients with persistent depression and their doctors "were searching for solutions."

Still, according to Sherbourne, it may be that more of these patients need a combination of medications and therapy, ongoing assessments by their doctors, or referrals to specialists.

The researchers also found that three patient characteristics made treatment failure more likely: suicidal thoughts, unemployment and lack of adherence to medication.

Suicidal thoughts denote more severe depression, Sherbourne explained, and lack of work could be a sign of poor functioning in daily life. As for non-compliance with drugs, she noted, side effects are often to blame when patients stop taking their medication before they should.

All of these factors could make a person's depression particularly hard to treat, according to Sherbourne.

Doctors should be "alert" for the broad range of factors from mental and physical health to daily life stress, she and her colleagues conclude, which could affect depression treatment.

Source: General Hospital Psychiatry, March-April 2004.

PsychLinks Online comment:
This definition of "minimally appropriate care" is extremely minimal - four therapy sessions is not enough time to do the work necessary to adequately treat major depression, and since the common antidepressants often take 4 to 6 weeks to even begin to show therapeutic benefits, two months on medication should not be expected to produce any significant lasting recovery. To me, the really scary statistic in this article is that "fewer than half of all patients in the study received what the researchers deemed minimally adequate care".
-- David Baxter