Persistence key to success in depression treatment

Progress in the STAR*D trial was measured by remission of depressive symptoms rather than reduction in symptoms.

By Susan J. Landers, AMNews staff. April 10, 2006.

Washington -- New findings from a large study on effective ways to treat depression lend support to intuitive approaches employed in physicians' offices to help their many patients with the disorder. The key theme among the strategies: Don't give up.

The Sequenced Treatment Alternatives to Relieve Depression trial, known as the STAR*D trial, found that one in three depressed patients who had not achieved remission using an antidepressant became symptom-free with the addition of another medication. One in four did the same after switching to a different antidepressant.

The findings from the multicenter trial are believed to be the first to examine the effectiveness of depression treatments for people who did not become symptom-free after initial treatment with medication.

Depression affects more than 19 million Americans and is the leading cause of disability in the nation, according to new statistics released in February by the Depression and Bipolar Support Alliance, a national group based in Chicago. The lack of specialists, including psychiatrists, often leads patients to seek help from their primary care physicians.

The need to help physicians help their patients already has been recognized. Maine, for example, is leading one such effort, said Neil Korsen, MD, a family physician for 18 years and now medical director of the Depression in Primary Care Program for MaineHealth, a nonprofit health system in Portland.

"I think that [STAR*D] will add support to what we've been doing based more on common sense than on research findings," Dr. Korsen said. He said he often had talked with colleagues about the need to treat depression more aggressively and to consider increasing dosage or changing medications if one approach doesn't seem to be working.