PsychoTropicalResearch, serotonin and serotonin syndrome research.
Depression - Treatment (2)
Depression - Treatment (2)
Date Created: 14/01/1999 Last Modified: 11/10/1999 Last Checked: 02/05/2002
As if the difficulties with under diagnosis of depressive illness were not enough, it is now clear that problems with under treatment of diagnosed cases are equally prevalent.
Insufficient attention has been paid to the common problem of incomplete recovery of depressive episodes. It is salutary to remind ones self that almost all drug trials use a 50% improvement as the criterion for ‘success’. We have arrived at the extraordinary position where a lessening of symptoms, but not a full recovery, is not only accepted as a satisfactory outcome, but is even used as a benchmark.
I view the evidence that serotonin and noradrenalin reuptake inhibitor (SNRIs) and combined treatments -- such as sertraline and reboxetine / desipramine / nortriptyline -- are more effective, and more likely to bring about complete recovery, as being sufficiently persuasive to act on. The evidence that more aggressive treatment of depression is both appropriate, and required, now deserves our attention.
The old notion of a maintenance dose has been firmly debunked. Continued therapy, at the same dose as was necessary to achieve initial improvement, is likely to be required. The relapse rate with lowered maintenance doses is significantly higher. It is also clear that, for patients who have two or more previous episodes, the chances of requiring therapy for three to five years, rather than twelve months or so, is great.
When this is combined with the significant evidence that two or more episodes increases risk of severity and chronicity it can be seen that the importance of continued treatment and prevention of relapse is great.
All text ©Dr Ken Gillman MRC Psych - PsychoTropical Research®
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