Taking Drugs at Least 9 Months Prevents Depression Relapse
It’s a big problem: Too many people don’t take antidepressants long enough to get the full benefit.
“A few weeks into it, people think ‘OK, I feel better, I don’t need to keep taking it anymore,” says study researcher Scott A. Bull, PharmD, a pharmacy research analyst at Kaiser Permanente in Oakland, Calif.
However, depression has a high rate of relapse - which very often occurs in the first year, according to Bull. “The goal of treatment is to prevent these relapses.” It can take 9 months of treatment - maybe up to a year - to help prevent a relapse.
But why do patients quit taking antidepressants? Bull sheds some light on the problem in the Sept. 18 issue of The Journal of the American Medical Association.
In their study, Bull and colleagues interviewed 99 doctors and 137 people with depression. People who had seen their doctors less than three times after starting their antidepressant were more likely to stop treatment because of side effects and because they did not clearly understand their treatment.
More patient-doctor visits are the answer, says Bull. “They provide an opportunity for these discussions to occur.”
It’s all very true, says Harold Koenig, MD, associate professor of psychiatry at Duke University School of Medicine.
“People who are depressed are not very motivated anyway,” he says. “They need to be encouraged, to get past the negative thinking - that this drug won’t work, that it costs too much. Side effects can be upsetting. Plus, there’s still a stigma about having to rely on a pill to feel normal.”
“These medications are very effective for treating depression. However, the body takes time to get used to them. They’re changing your brain’s biochemistry,” Koenig says. Patients need to know that if one medication doesn’t work, another one might.
Getting past initial side effects requires “toughing it out,” Koenig says. “A lot of times people have to get over a hill - side effects - before they get to the valley. It can take a month to six weeks to get past that period. But that doesn’t happen until you take the pills religiously - every day - because they have to build up in your system.”
If this is the first depression - and it’s clearly linked with an event like divorce or job loss - antidepressants may be necessary for no more than a year or so, Koenig says.
For people who have been depressed before, the drugs may be about the only way to get past depression. “Every episode actually creates permanent changes in the brain,” he says. “Antidepressants are very effective in treating severe depression.”
First Line Antidepressants
The SSRI antidepressants, escitalopram (Lexapro), Fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), or sertraline (Zoloft), are considered excellent choices as the patient’s first antidepressant because of their low incidence of side-effects (especially weight gain) and their low lethality if taken in an overdose. All SSRI antidepressants are equally effective.
Because many patients with major depression also suffer with intense anxiety, your doctor may also give you Fluvoxamine (Luvox) or lorazepam (Ativan) to reduce anxiety in mixed anxiety-depression.
Both Fluoxetine (Prozac) and paroxetine (Paxil) tend to be stimulating (elevate your mood); thus patients with mixed anxiety-depression can often dramatically benefit from the addition of clonazepam (Klonopin) to the Fluoxetine (Prozac) or paroxetine (Paxil) therapy.
Revision date: July 4, 2011
Last revised: by Dave R. Roger, M.D.