Second try at antidepressants often works

In the long and frustrating battle against depression, persistence does pay.

A major new government study reports Thursday that at least a quarter of depressed patients who fail to achieve a complete remission with their first course of drug treatment can do so by adding a second drug or by switching drugs.

Overall, about half of the nearly 1,500 patients in the study achieved remission, which is the complete absence of symptoms, by completing two treatment steps, and many others showed improvement.

For the first time, the study provides a scientifically based roadmap for how depressed patients should be treated. In the past, most treatment “has been driven by anecdotes, a small series of case reports, 10 patients helped by one combination, 15 by another,” said Andrew Leuchter of the University of California, Los Angeles, who participated in the study.

“This is the largest study ever to look at what is the best next step if you don’t get well in the first step” of treatment, he said.

Many patients also give up if they don’t get an immediate response with the first drug they try or if they suffer unpleasant side effects.

The message to patients and physicians is “hang in there,” said A. John Rush of the University of Texas Southwestern Medical Center, who led the trials, reported Thursday in the New England Journal of Medicine.

“For the depressed person, it may not matter so much what drug is being prescribed, but that the person moves forward and keeps trying,” he said.

Depression is a devastating illness that affects nearly 15 million Americans each year and is the leading cause of disability between the ages of 15 and 44.

It is “an utter sense of hopelessness,” said Thomas Insel, director of the National Institute of Mental Health, which sponsored the six-year and $35 million study.

The disorder is the cause of 30,000 suicides each year and is responsible for the loss of $86 billion in productivity.