This research was based on over 3.6 million patients with major depression who used over 10 million antidepressants, as categorized into over 16,000 subgroups of conditions, demographic information, and prescriptions. The Centers for Disease Control and Prevention (CDC) estimates that 1 of every 6 adults will experience depression in their lifetime, as it impacts approximately 16 million Americans annually, so research like this may improve the lives of many individuals navigating treatment options.
The Research
This retrospective, observational, matched case-control study was conducted with depressed patients who had been treated with antidepressants between 2001 and 2018 across the US. In this study, researchers analyzed data from 3,678,082 patients with major depression who used a total of 10,221,145 antidepressants, from which, 16,770 subgroups of patients were created to calculate the remission rates for various antidepressants within the subgroups. This free decision aid was developed to assist with choosing the optimal antidepressant based on which subgroup matches the medical history of a patient to recommend an appropriate course of treatment. A limitation of this study was its use of a convenient sample, rather than random, so generalization of these findings may be less feasible.
Delays with Treatment
Behavioral health medical director at Community Health of South Florida Inc., psychiatrist Howard Pratt, DO, says, “Antidepressants in combination with therapy are the best treatment for depression.” Dr. Pratt notes that some anti-depressants may be better suited for patients based on their symptoms, accompanying medical conditions, etc. “The biggest hurdle people face when confronting depression is trusting treatment as well as trusting their doctor," he says. When dealing with depression, patients are often told that it may take as many as six weeks before the benefits of an anti-depressant begin to be felt, so Dr. Pratt explains that they may come to feel like this is a problem that will never end, but this is not the case, thankfully. Dr. Pratt explains that an individual may take months or even years to even acknowledge that they may be experiencing depression, so something that takes that long to develop and then be acknowledged may take time to be treated. “Mental health is a journey, not a destination,” he says. From his experience, Dr. Pratt describes that patients may sometimes have reservations regarding a treatment plan, which may result in them initially only taking half of the prescribed dosage, or taking the medication every other day rather than daily, but discussions can put doubts to rest.
Gathering Thorough Information
Elisabeth Netherton, MD, a psychiatrist with MindPath Care Centers, a Community Psychiatry Practice, says that this research study highlights the value of working with a mental health provider who takes the time to take a thorough account of the patient’s history. Dr. Netherton says, “It is so important for us to know about what has helped (or not helped) in the past, what symptoms have looked like for you in the past, and about other people in your family who might struggle with similar challenges so that we can make good choices for treatment.” Since medication is not the only option to treat depression, Dr. Netherton notes that evidence-based psychotherapy is highly effective for treating both anxiety and depression. “Whenever I am recommending medication for my patients, I am also wanting them to be in individual therapy to get the best chance of relief from their symptoms,” she says. Dr. Netherton highlights, “This study is particularly exciting because it focuses on real-world care provided to patients with multiple comorbidities. Often, in research studies about mental health treatments, patients are only included if they have just one diagnosis, are on just the medication under study, and if they don’t have other psychiatric or medical problems.” Given that such study populations do not often represent the reality of complex patients, Dr. Netherton notes, “Many people seeking treatment for depression also struggle with anxiety, and often need more than one medication; the lack of research on these more authentic but more complicated medical populations can make it hard to apply data from research studies to real-world scenarios with our patients.” Dr. Netherton explains, “This study adds to our understanding of what is useful for the typical patient, not for an ideal patient in a drug trial.” She recommends that patients may further benefit from keeping a record, which outlines past diagnoses, procedures, medications, etc. In this way, Dr. Netherton notes, “Often when we go see providers, we can’t remember well what we’ve taken before and if it caused side effects, so keeping it in a safe, consolidated place can help you and your future providers select treatments most likely to benefit you.”
