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New Treatment Strategy for the Prevention of Recurrent Depression
November 07, 2006Some patients who experience recurrent depression may benefit from long-term maintenance treatment with anti-depressant medication, according to a new study led by a Virginia Commonwealth University researcher.
Major depressive disorder is a recurrent condition that can have a profound impact on an individual's quality of life. In the United States, approximately 17 percent of individuals will experience major depressive disorder during their lifetime.
Of those who experience one episode of major depression, more than 50 percent will have a recurrence. After two episodes, more than 70 percent of patients will have a recurrence, and after three episodes that figure jumps to 90 percent. Each episode poses a new risk that the depression may not respond to treatment, making prevention of recurrent depression an important focus of long-term treatment.
In the November issue of the Journal of Clinical Psychiatry, Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU's School of Medicine and lead author on the study, reported with her colleagues that maintenance treatment with escitalopram, a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression, may reduce the risk of recurrent depression in patients with major depressive disorder.
Between 2000 and 2003, researchers evaluated approximately 200 participants at 28 centers in the United States who had responded positively to eight weeks of treatment with one of four different SSRIs: fluoxetine, sertraline, paroxetine or citalopram. This was followed by four months of treatment with escitalopram. These participants were then randomly assigned to fixed-dose treatment with 10 or 20 mg of escitalopram or placebo for one year.
"Patients who were switched to placebo showed a significantly higher rate of depression recurrence (65 percent), compared to those who stayed on escitalopram (27 percent)," said Kornstein. "This was true even though the patients showed a full resolution of their depression at the start of maintenance treatment." The medication was found to be safe and well tolerated throughout the study, she said.
"These findings indicate the importance of maintenance therapy for patients with recurrent major depressive disorder beyond four to six months of improvement, even if a patient's depressive symptoms appear to be resolved," she said.
This work was funded by Forest Research Institute.
Kornstein is also the executive director of VCU's Mood Disorders Institute and VCU's Institute for Women's Health, designated a National Center of Excellence by the U.S. Department of Health and Human Services. She collaborated on the study with Anjana Bose, Ph.D., Dayong Li, Ph.D., Khalil G. Saikali, Ph.D., and Chetan Gandhi, Ph.D., who are researchers with Forest Research Institute.
Virginia Commonwealth University
In the November issue of the Journal of Clinical Psychiatry, Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU's School of Medicine and lead author on the study, reported with her colleagues that maintenance treatment with escitalopram, a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression, may reduce the risk of recurrent depression in patients with major depressive disorder.
Between 2000 and 2003, researchers evaluated approximately 200 participants at 28 centers in the United States who had responded positively to eight weeks of treatment with one of four different SSRIs: fluoxetine, sertraline, paroxetine or citalopram. This was followed by four months of treatment with escitalopram. These participants were then randomly assigned to fixed-dose treatment with 10 or 20 mg of escitalopram or placebo for one year.
"Patients who were switched to placebo showed a significantly higher rate of depression recurrence (65 percent), compared to those who stayed on escitalopram (27 percent)," said Kornstein. "This was true even though the patients showed a full resolution of their depression at the start of maintenance treatment." The medication was found to be safe and well tolerated throughout the study, she said.
"These findings indicate the importance of maintenance therapy for patients with recurrent major depressive disorder beyond four to six months of improvement, even if a patient's depressive symptoms appear to be resolved," she said.
This work was funded by Forest Research Institute.
Kornstein is also the executive director of VCU's Mood Disorders Institute and VCU's Institute for Women's Health, designated a National Center of Excellence by the U.S. Department of Health and Human Services. She collaborated on the study with Anjana Bose, Ph.D., Dayong Li, Ph.D., Khalil G. Saikali, Ph.D., and Chetan Gandhi, Ph.D., who are researchers with Forest Research Institute.
Virginia Commonwealth University
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Depression has long had a popular link to cardiovascular disease and death. However, only during the last 15 years scientific evidence supporting this common wisdom has been available (Glassman et al., 2007a). Since the early 1990s studies have reported prevalences of major depression between 17% and 27% in hospitalized patients with coronary artery disease (CAD) (Rudisch & Nemeroff, 2003).
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Most women with recurrent depression may be able to prevent subsequent depressive episodes with monthly maintenance interpersonal psychotherapy (IPT).
Antidepressant drug may prevent recurrence of depression in patients with diabetes
A team of researchers at Washington University School of Medicine in St. Louis found that an antidepressant medication may reduce the risk of recurrent depression and increase the length of time between depressive episodes in patients with diabetes.
Antidepressant medication may prevent recurring depression in diabetics
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Possible brain hormone may unlock mystery of hibernation
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Are Depressed Patients Exploited By The Drug Industry?
A study published in the October issue of the American Journal of Psychiatry by an Italian group of investigators headed by Professor Giovanni A. Fava (University of Bologna) suggests, that with appropriate psychosocial interventions, half of the patients with recurrent depression could be still well and drug free six years after termination of treatment, instead of being linked to long term drug treatment. A number of controlled trials have suggested that cognitive behavior strategies may decrease the risk of relapse in major depressive disorders. The risk of relapse in depression is strongly related to the number of depressive episodes and to the amount of residual symptoms. There is a pa
Can Antidepressant Drugs Prevent Recurrence Of Depression? The News Is Depressiong.
Prolonging antidepressant drug treatment to prevent recurrence of depression does not appear to be an optimal solution for many patients concludes a review of Giovanni A Fava, Chiara Ruini (University of Bologna) and Nicoletta Sonino (University of Padova). The chronic and recurrent nature of major depressive disorder is receiving increasing attention. Approximately eight of ten people experiencing a major depressive episode will have at least one more episode during their lifetime, i.e. recurrent major depressive disorder. In the 1990s, prolonged or lifelong pharmacotherapy emerged as the main therapeutic tool for preventing relapses of depression. This therapeutic approach based on the eff
How Long Should Drug Treatment Of Depression Last?
Three Italian researchers (Drs Fava, Ruini and Tossani of the University of Bologna) challenge the Australian guidelines for treatment of depression. The beyondblue guidelines for treating depression in primary care by Ellis and Smith are intended to assist both healthcare professionals and consumers. While they provide several helpful indications, they also include some misleading suggestions. The authors state that drug treatment of depression should continue for at least one year for a first episode of depression, and at least two years for repeated episodes or when there are other risk factors for relapse. Maintenance pharmacotherapy has been advocated as an effective tool for reducing r
When Depression Comes Back: What To Do Is Not What "Big PHRMA" Wants You To Do.
Relapse is a major problem for depressed patients. With this review, Psychotherapy and Psychosomatics launches a new section (case Management), which addresses management of cases in clinical practice. Investigators with conflict of interest are excluded from contributing. The Authors are from the Department of Psychology of the University of Bologna (Drs Fava and Ruini) and the Department of Mental Health of Padova (Dr Sonino). They discuss the case of a 37-year-old woman with a major depressive episode of recent onset. She had 2 previous episodes 1 and 3 years earlier, which had been treated by her primary care physician with fluoxetine for 6 months each time. There is no evidence of bipol
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