GOAL OF TREATMENT:
The lifetime prevalence of depression is estimated to be 16.2% in the general population, indicating that more than 30 million adults (about 1 in 6) in the United States will experience an episode of depression.(1) Many individuals with depression contemplate medication for treatment. Best results for treatment are medication combined with therapy and a regular exercise program. Here is some information the consumer needs to be aware of regarding depression and anti-depressants. There are a large number of safe and effective antidepressants that are generally well-tolerated with minimal, time limited (2 to 4 weeks) side-effects.
The goal of the treatment of depression is remission, meaning the complete or near-complete resolution of all symptoms.(2) Current guidelines suggest the acute phase of treatment—when medication is started—generally lasts for up to 12 weeks. In the acute phase, the treatment goal is to get the depression into remission, the point at which symptoms are completely, or nearly completely, gone. Once the depression is in remission, consumers enter the maintenance phase of treatment, which should last for an additional four to nine months.(3) The main problem is that many consumers do not remain on medication long enough to reach remission, let alone stay on medication for the additional recommended months. Up to 33% of patients stop medication within the first month, and up to 44% discontinue medication within three months of initiating therapy.(4-6) This often progresses to a more intensive re-occurrence of the depression – and consumers state “I feel like myself again” meaning the depression has returned. Many times, the consumer is the last person to recognize depression has taken hold – spouses, parents, peers, and colleagues are often the first line of defense.
Two of the many reasons consumers discontinue antidepressant medication are intolerance to the medication (adverse events) and lack of response (either partial or complete). When a consumer is having intolerable side effects, or when a patient is not responding to an antidepressant, consumers are recommended to consult with their MD or therapist about treatment options which may include choose to switching from one antidepressant to another.
SIDE EFFECTS OF ANTIDEPRESSANTS
Side effects from antidepressant medication include those that occur during the acute phase of treatment, as well as those that become problematic during long-term treatment, such as weight gain and sexual dysfunction. Common adverse effects of antidepressants may result in the need to switch medication.
Adverse side effects are consumer specific – meaning it is difficult to get a true picture of the adverse effects a consumer can expect from any single antidepressant until the consumer begins the treatment. Many beliefs about the side-effect profiles of antidepressants are based on the marketing data of pharmaceutical companies and treatment providers experiences with small numbers of patients. However, we do know of the common side-effects produced by specific anti-depressants. Some include headaches, metallic taste in mouth diarrhea, mild nausea, and others (these are often temporary lasting 1 to 3 weeks).
Up to 60% of consumers taking an anti-depressant will experience some degree of sexual dysfunction such as delayed orgasm, inability to have an orgasm, and/or decreased libido.(7) While each medication may claim different rates of sexual dysfunction, this adverse effect appears to be apply to almost all SSRI’s (anti-depressants). There are medicinal strategies to manage this side effect and a consumer should consult with his or her treatment provider. (8) Weight gain is also a common late side effect of antidepressants. Nutritional counseling and exercise are usually the only measures necessary to deal with this problem.
WHEN DOES A CONSUMER KNOW THE MEDICATION IS NOT WORKING?
In most cases, many consumers placed on a reasonable dose of an antidepressant begin to experience relief within 2 to 9 days with more pronounced relief of symptoms after 4 weeks.
It is estimated that 12% to 15% of consumers will partially respond and 19% to 34% will not respond at all to a given antidepressant medication. (9)
Options available to consumers who do not achieve remission on a single antidepressant include increase dosage, additional treatment with a second drug, and/or switching to a new medication.
Consumers with depression should have at least 3 follow-up visits during the first 12 weeks of treatment.(10)
The longer consumers stay on medication, the more likely they are to get to remission and enjoy life!
- Kessler RC, et al. JAMA. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication 2003;289:3095-3105.
- American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder [revision]. Am J Psychiatry. 2000; 157(4 suppl):1-45.
- Depression Guideline Panel. Depression in Primary Care, Vol. 2: Treatment of Major Depression. Rockville, Md: US Dept of Health and Human Services, Public Health Service, and Agency for Health Care Policy and Research; 1993. Clinical Practice Guideline No. 5.
- Simon GE, VonKorff M, Wagner EH, et al. Patterns of antidepressant use in community practice. Gen Hosp Psychiatry. 1993;15:399-408.
- Venturini F, Sung J, Nichol M, et al. Utilization patterns of antidepressant medications in a patient population served by a primary care medical group. J Manag Care Pharm. 1999;5:243-249.
- Lin EH, VonKorff M, Lin E, et al. The role of the primary care physician in patient’s adherence to antidepressant therapy. Med Care. 1995;33:67-74.
- Masand PS, Gupta S. Selective serotonin-reuptake inhibitors: an update. Harv Rev Psychiatry. 1999;7:69-84.
- Keltner NL, McAfee KM, Taylor CL. Mechanisms and treatments of SSRI-induced sexual dysfunction. Perspectives in Psychiatr Care. 2002;38: 111-116.
- Fava M, Davidson KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am. 1996;19:179-200.
- National Committee for Quality Assurance. HEDIS 2000: Technical Specifications. Vol 2. Washington, DC: National Committee for Quality Assurance; 1999:105-110.