As Antidepressants Begin to Work, Hopelessness Can Linger

People taking medication for depression typically see a lot of improvements in their symptoms during the first few months, but lagging behind other areas is a sense of hopefulness, according to new research from the University of Michigan Health System.

That means people with depression may still feel a sense of hopelessness even while their condition is improving, which could lead them to stop taking the medication.

For many in the study, feelings of hopefulness did not improve until several weeks, or even months, after depressive symptoms lifted, says lead author James E. Aikens, Ph.D., associate professor in the Department of Family Medicine at the University of Michigan Health System.

“The finding suggests that some patients may become unduly pessimistic and stop adhering to an already-helpful therapy,” he notes. This finding is troubling, he says, because hopelessness is a strong risk factor for suicide.

The study appears in the January-February issue of the journal General Hospital Psychiatry.

Aikens and his team studied 573 patients with depression from 37 practices. They were given an antidepressant, either fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft). They were assessed one, three, six and nine months after the treatment began.

Overall, patients’ depression responded rapidly to medication, with 68 percent of their improvement occurring by the end of the first month, and 88 percent by three months. The patients experienced the majority of their improvement in several areas during this time period, including positive emotions, work functioning and social functioning.

Improvements in head, back and stomach pain plateaued during the first month, with little improvement thereafter. Because of that, Aikens says, physicians may want to consider additional treatments that directly target pain in depressed patients if these physicial complaints persist after the first few weeks of treatment with antidepressants.

With hopefulness, however, the improvement was much more gradual. Physicians may want to consider cognitive-behavioral strategies, such as teaching patients to identify and challenge the pessimistic thoughts that usually accompany depression, and encouraging them to engage in activities that may improve their mood, Aikens says.

In addition to Aikens, authors were: senior author Amanda Sen, Ph.D., of the Department of Family Medicine, the Department of Statistics and the Center for Statistical Consultation and Research at the University of Michigan; Donald E. Nease Jr., M.D., of the Department of Family Medicine at the U-M Health System; Michael S. Klinkman, M.D., M.S., of the departments of Family Medicine and Psychiatry at the U-M Health System; and Kurt Kroenke, M.D., of Indiana University.

The original study that tested antidepressants was conducted by Eli Lilly Inc. The current secondary data analysis was conducted by the authors, not the sponsor. Also, Aikens has served as paid consultant to Pfizer; Klinkman has served as a paid consultant to Wyeth Pharmaceuticals; and Kroenke has received honoraria from Pfizer, Eli Lilly and Wyeth.