Management of depression could be better
A number of patients classified as being “adequately” treated with selective serotonin reuptake inhibitors in primary care do not respond to the therapy, say researchers.
Data were obtained from the ARTIST trial (a randomised trial investigating
SSRI treatment), which involved 601 patients.
In the study 64 per cent of patients were classified as being treated
with an adequate dose of medication for an adequate duration of time,
yet only 23 per cent of patients achieved complete remission. After six
months of treatment, 46 per cent of the 482 patients assessed were classified
as not responding to the treatment and 32 per cent were classified as
partially responding.
The authors say that some of these patients may be considered under-treated
or treatment-resistant according to current treatment guidelines. In
these cicumstances dose increases or medication switches may be required.
The authors state that this highlights the need to redefine adequacy
of treatment within the context of clinical improvement, although they
acknowledge that the treatment classification guidelines used in this
study were more conservative than those usually found in standard clinical
practice.
The researchers also note that there appears to be substantial numbers
of patients with treatment resistant depression who are being treated
in primary care. They found that 13 per cent of patients reported receiving
aggressive treatment strategies usually only necessary for addressing
treatment resistance.
They say that efforts should be made to increase the intensity of treatment for
patients in whom initial treatment fails but also for patients who only achieve
a partial response (Archives of Internal Medicine 2004;164:1197). |
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