Double Depression Treatment Cuts Remission Rate

[Halo]

Drug Cocktail Twice as Effective for Depression - Duplicate Post!!

DRUG COCKTAIL TWICE AS EFFECTIVE FOR DEPRESSION: Royal Ottawa study
Laura Hendrick, National Post
Friday, January 26, 2007

A doctor at the Royal Ottawa Mental Health Centre says he has doubled recovery rates for people suffering from depression using a cocktail of drugs.

Dr. Pierre Blier boosted recovery rates to 60 per cent using a combination approach from 24 per cent when medications like Prozac are used alone.

Currently, doctors only prescribe multiple antidepressants as a last resort.

However, Dr. Blier, who estimates more than five million Canadians suffer from depression at some point in their lives, said the combination approach should be used at the outset to save patients a prolonged struggle.

"Normally, when a patient seeks help, they've been suffering for a while, so the doctor thinks, 'What's the rush?'" said Dr. Blier, the head scientist for the study to be released today. "But it is urgent, and you have to treat it rapidly. Single medications like Prozac or Zoloft are not very effective."

Dr. Robert Levitan, a psychiatrist with the University of Toronto, said that the high cost of medication along with the difficulty of monitoring two drugs simultaneously has made him wary of the cocktail approach.

"It makes sense to me for someone who has a combination of problems like sleeplessness and depression," he said yesterday. "But in real life people don't like being on a lot of medications."

Dr. Blier said the combination works because the antidepressants cancel out each other's side effects. By pairing a stimulant like Prozac with a sedative like Remeron, he saw much faster symptomatic relief with a lower drop-out rate from his patients.

He hopes the treatment will significantly reduce some of the 4,000 suicides that occur in Canada each year.

New York's Columbia University, which has seen the results of Dr. Blier's study plans a much larger study of the use of a cocktail of drugs to treat depression.

 

[David Baxter PhD]

New Depression Treatment Cuts Remission Rate
January 28, 2007
Toronto Daily News

Using two depression medications at the time of diagnosis is safe, well tolerated, and markedly improves success in the first six weeks of depression treatment.

Depression should be treated quickly and more than one medication can be used simultaneously in order to speed recovery in people suffering from depression, this highly prevalent and debilitating mental illness, new study shows.

Two medications prescribed from treatment initiation makes a significant difference in remission of depression, results of studies conducted by Dr. Pierre Blier, Canada Research Chair in Psychopharmacology at the University of Ottawa Institute of Mental Health Research, show.

In studies led by Dr. Blier, the remission rate obtained with a combination of anti-depressants Remeron, with Prozac, Effexor, or Wellbutrin ranged between 50 to 60 per cent after six weeks of treatment, compared to Prozac alone, which produced only a 25 per cent remission rate.

"Several illnesses are treated with two medications from the very beginning," said Dr. Blier. "In the case of major depression, physicians generally try one medication at a time to see which one works best for the patient. Each of these attempts requires a minimum of six to eight weeks, each with a remission rate between 30 to 40 per cent. This standard of care is not nearly as effective as it could be."

The number of depression patients stopping their treatment because of side effects was similar in all drug treatment regimes, indicating that the medication combinations are well tolerated. In patients who were in remission on the combination depression drug approach, the discontinuation of one medication after six weeks produced a relapse in 40 per cent of the cases, suggesting that in some patients the combination approach achieved the remission.

Using two depression medications at the time of diagnosis is not only safe and well tolerated, but it markedly improves success in the first six weeks, said Dr. Blier. Patients should not have to wait to fail on various single medications before using two medications at once, he suggests.

 

[braveheart]

I was on remeron and efexor both for a while. My psychiatrist said it was the combo used for long-standing treatment resistant depression.It did help. Now I'm only on remeron.

 

[Halo]

Braveheart,

I am really interested in this whole issue of medication combinations and was wondering if you tried many different medications prior to the Remeron and Effexor combination?

 

[braveheart]

Nope. I was on efexor for a year. I was not doing that well, still very anxious, not sleeping, crying and very distressed and hurting myself. Also not eating. I was refered to the psychiatrist to sort out my meds, and he put me on remeron, at first in addition to efexor, and then tapering off the efexor to remain only on remeron.

The only psych med I was on before efexor was zopiclone [sleeping tablets] prn, which seems to be the standard practice in UK GP for people suffering emotionally before they put them on Anti-deps.

 

[Halo]

So obviously the Effexor wasn't working and your psych added in Remeron...did you notice a difference when it was added in and if so did it work well enough that you didn't need the Effexor anymore?

I apologize if I am asking a lot of questions but I am having some serious medication issues and am trying to sort things out for myself.

Thanks

 

[braveheart]

Efexor wasn't really working. For a start, the dr who'd prescribed it to me had never met me before, didn't ask any questions. I just told him my therapist and I had agreed I needed medication/anti-depressants. He saw me edging my chair to the other side of the room away from him, and gave me the efexor. He didn't even tell me what it was until I asked.
When I started to see my current GP, who I have been seeing now regularly for 2 years... they just kept me on efexor because that was what I was on.
Bit bad, really.
Anyway, when I got put on the remeron, I noticed an immediate difference. For a start, I was able to sleep for pretty much the first time ever.
I admit to having some jaw clenching and headaches whilst on both. I also noticed that, when tapering off efexor, I was most stable on half my original efexor dose, along with the remeron.
The original plan was to take me off efexor gradually. It clearly wasn't 'my' med, and they don't like to keep you on 2 for an extended period. Its mainly to boost out from the deepest darkness.
I have been pretty much stable just on remeron.
Apart from extra stressful times when I could have done with a booster.
Also my anxiety needs additional medication support from time to time, which is why I have propranolol. [which I vary in my enthusiasm about]

 

[David Baxter PhD]

Thank you for your feedback about your experiences, braveheart. I've found it very interesting and very helpful.

 

[braveheart]

You're welcome.

 

[Halo]

Thank you so much Braveheart as I really appreciate you sharing your experience with me and others and what was great to read in your post was this:

Anyway, when I got put on the remeron, I noticed an immediate difference.

After reading the above article and your experience as well, it gives me some hope with my situation.

Thanks again

 

[braveheart]

Thank you also Nancy for posting the article, its always good to read validation of my treatment.

 

[Into The Light]

great thread, it gives more hope for people with depression to know that there are even more options out there with regard to medication than one might think.

 

[Halo]

great thread, it gives more hope for people with depression to know that there are even more options out there with regard to medication than one might think.

It definitely does