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Antipsychotic Meds Not That Helpful for Depression: Study

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For people who don’t fully respond to antidepressants, adding commonly prescribed antipsychotic drugs appears to be only slightly effective and is linked to unwelcome side effects, a new depression study finds.

Many people think that participating in a research study means they will get better treatment for their illness. While this may be true, it’s important to remember that a research study is conducted for research purposes—it does not ensure better or safer treatment.

Drugs added to antidepressants ( like Prozac, Paxil and Celexa ) include the antipsychotic medications aripiprazole ( Abilify ), quetiapine ( Seroquel ), risperidone ( Risperdal ) and olanzapine/fluoxetine ( Symbyax ).

Antipsychotic drugs are traditionally used to treat conditions such asschizophrenia, bipolar disorder and obsessive-compulsive disorder — not depression.

“The evidence supporting the use of anti psychotics in depression is marginal” said lead researcher Glen Spielmans, an associate professor in the department of psychology at Metropolitan State University in St. Paul, Minn.

 Anti psychotic treatment of depression has become increasingly widespread but the underlying evidence base puts this practice into question, he said.

“Other options may be as effective, or more effective, and carry a lesser side-effect burden,” Spielmans said. For instance, cognitive behavioral therapy has been shown to be effective for treatment-resistant depression, he said. Cognitive behavioral therapy is a treatment that helps patients try to change their thoughts, feelings and behaviors.

For one expert, these drugs also aren’t a first choice for patients who don’t respond fully to antidepressants.

“I have mixed results in terms of how effective they are,” said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Hill Hospital, in New York City.

“I treat a lot of patients who are on antidepressants and not responding well. Prescribing these drugs is not something I do often because of the costs and because of the side effects,” said Bruno, who was not involved with the study.

Some of these drugs are pricey. For example, Abilify can cost more than $200 a month without insurance, according to the Everyday Health website. With insurance the cost varies by plan.

“I prefer using other strategies like adding other antidepressants, or using brain stimulation treatments, and psychotherapy,” Bruno said.

For some patients, however, these antipsychotics can be helpful, including those with insomnia and those whose depression is coupled with a psychosis, he noted.

The report was published in the March issue of the online journal PLoS Medicine.

To gauge the effectiveness of these drugs, Spielmans’ team pooled data from 14 studies that compared antipsychotic medications to an inactive placebo in patients for whom antidepressants weren’t enough to relieve depression.

This process, called a meta-analysis, attempts to find common threads from different studies that reveal a pattern, which adds information beyond what one study finds.

The new analysis found these drugs offered only a small benefit in relieving symptoms of depression and little or no benefit in improving patients’ quality of life or ability to function.

Depression is a serious mental health concern that will touch most people’s lives at some point in their lifetime (either directly or through someone close they know). The suffering endured by people with depression and the lives lost to suicide attest to the great burden of this disorder on individuals, families, and society. Improved recognition, treatment, and prevention of depression are critical public health priorities. Organizations such as the National Institute of Mental Health (NIMH), one of the world’s leading mental health biomedical organizations, conducts and supports research on the causes, diagnosis, prevention, and treatment of depression in the United States.

Clinical depression is a serious condition that negatively affects how a person thinks, feels, and behaves. In contrast to normal sadness, clinical depression is persistent, and significantly interferes with daily life. Untreated, symptoms can last for weeks, months, or years; and if inadequately treated, depression can lead to other health-related issues. Symptoms include: a depressed mood most of the day, every day; diminished interest in daily activities; changes in appetite and sleeping patterns; fatigue; restlessness; anxiety; feelings of worthlessness or helplessness; difficulty concentrating; increased alcohol or drug use; thoughts of death or suicide.

The drugs did, however, have some unwelcome side effects such as restlessness, sleepiness, weight gain and some abnormal lab test results such as increased cholesterol levels, the researchers reported.

Spielmans suggested that some of the trials they looked at may have tried to boost the perception of the effectiveness of the drug and downplay its side effects.

Evidence from neuroscience, genetics, and clinical investigation demonstrate that depression is a disorder of the brain. Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters — chemicals used by nerve cells to communicate — are perhaps out of balance. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better medical and psychotherapy treatments.

“Studies were sometimes designed in a biased manner that may have slanted the results,” Spielmans said. “Data were sometimes reported in a way that likely made the drugs appear more effective than they actually were.”

In addition, he said, the researchers found that some side effects were tucked away on the U.S. Food and Drug Administration’s website and in clinical trial registries rather than being reported in the published medical journal reports of the studies.

Symptoms and Types of Depression

Symptoms of depression include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide. A diagnosis of major depressive disorder (or unipolar major depression) is made if an individual has five or more of these symptoms during the same two-week period. Unipolar major depression typically presents in discrete episodes that recur during a person’s lifetime.

Bipolar disorder (or manic-depressive illness) is characterized by episodes of major depression as well as episodes of mania — periods of abnormally and persistently elevated mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity or physical agitation; and excessive involvement in pleasurable activities that have a high potential for painful consequences. While sharing some of the features of major depression, bipolar disorder is a different illness that is discussed in detail in a separate NIMH publication.

Dysthymic disorder (or dysthymia), a less severe yet typically more chronic form of depression, is diagnosed when depressed mood persists for at least two years in adults (one year in children or adolescents) and is accompanied by at least two other depressive symptoms. Many people with dysthymic disorder also experience major depressive episodes. While unipolar major depression and dysthymia are the primary forms of depression, a variety of other subtypes exist.

There is a high degree of variation among people with depression in terms of symptoms, course of illness, and response to treatment, indicating that depression may have a number of complex and interacting causes. This variability poses a major challenge to researchers attempting to understand and treat the disorder. However, recent advances in research technology are bringing NIMH scientists closer than ever before to characterizing the biology and physiology of depression in its different forms and to the possibility of identifying effective treatments for individuals based on symptom presentation.

In contrast to the normal emotional experiences of sadness, loss, or passing mood states, depression is extreme and persistent and can interfere significantly with an individual’s ability to function. In fact, a recent study sponsored by the World Health Organization and the World Bank found unipolar major depression to be the leading cause of disability in the United States and worldwide.

Did you know that almost 7% of the U.S. population is diagnosed with depression?

Research has shown that peoples’ thoughts and feelings are strongly connected. This study aims to learn more about how different styles or ways of thinking can affect peoples’ moods, both positively and negatively.

February 16, 2014 |

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