Changing Medicine May Not Help With Depression

Sixteen million Americans deal with major depression according to government data, but a recent study finds that the best way to help these patients deal with depressive symptoms may be to avoid switching their medication. 

The study, published in the Journal of the American Medical Association (JAMA), involved more than 1,500 patients at 35 U.S. Veterans Health Administration medical centers who were diagnosed with major depressive disorder and were unresponsive to previous antidepressant treatment. Study participants were randomly assigned to one of three treatments: sticking to their original antidepressant, using their original antidepressant in combination with another drug or switching their medication entirely. Study participants were evaluated for nine months.

Researchers found that when patients were prescribed an antipsychotic medication or another antidepressant, their symptoms improved more than if doctors changed their medication. Twenty-nine percent of patients who took their original medication for three months, along with Abilify, an antipsychotic drug, were almost completely cured of their symptoms. Twenty-seven percent of patients who took the antidepressant bupropion in combination with their original medication were almost rid of their symptoms, while 22 percent who changed their medication were in this category.

The study suggests that changing the medication of someone with major depression may not be the best treatment approach for patients. Even if someone doesn’t respond to their original medication, adding another antidepressant, especially Abilify, may ease their symptoms and work better than switching their medication altogether, according to this recent research.

Fewer than one-third of the 16 million Americans with major depression disorder respond to the first antidepressant they are prescribed, so switching to a different medication may not be the first and best option for some people. Other research supports this. A review of 128 studies published last year found that using antidepressants along with antipsychotic drugs produced a small, but beneficial effect for patients. Researchers also found that this approach was safe for patients, and estimated that symptoms could be improved in 1 out of 9 people by using this treatment. 

However, I’d still be cautious about the results of the JAMA study and what it suggests. Basically, there’s still very little response to the medications — a 29 percent response for patients who took their medication for three months, a 27 percent response for people who took their medication in combination with an antidepressant and a 22 percent response rate for those who changed their medication entirely. There’s a statistical difference, but how does that relate to clinical significance? Looking between the groups’ differences, the medication with the highest success, atypical antipsychotics, are extremely powerful and somewhat dangerous medications and carry with them a large amount of side effects. In these cases, someone’s depression may improve, but they may experience symptoms like restlessness, fatigue and weight gain.

Millions of people deal with depression, a major health issue that also can lead to mortality in patients who are undiagnosed or don’t receive effective or timely treatment. One of our most difficult ongoing challenges is figuring out what treatments will work best for patients and at the same time won’t produce severe side effects that make it less likely someone will continue to take their medication.

Medications are just some of the tools available to help depression. Adding exercise and psychotherapy all have been shown to help, as well. As psychologists, we want to try everything possible before referring a patient to a psychiatrist for medication, as psychotherapy often has an equivalent effect (or even larger) and can last more long-term. To be clear, medications can be very helpful, but as this study suggests, they don’t always work for as many people as we’d like.