News
New Poll Suggests People Benefit from All Types of Depression Treatments
The National Institute of Mental Health conducted a major study (named STAR*D) which examined how physicians and their patients who have major depressive disorders can use symptom assessment to select, adjust and/or combine medication treatment approaches. (2006)
…”The overall goal of the STAR*D trial was to assess the effectiveness of depression treatments in patients diagnosed with major depressive disorder, in both primary and specialty care settings. It is the largest and longest study ever conducted to evaluate depression treatment. Read more about STAR*D. (Emphasis added)
“Each of the four levels of the study tested a different medication or medication combination. The primary goal of each level was to determine if the treatment used during that level could adequately treat participants’ major depressive disorder (MDD). Those who did not become symptom-free could proceed to the next level of treatment.“(Emphasis added)
In this way, the study triaged depressed patients. If Stage I produced remission of symptoms, those patients went on maintenance. If not, the patient proceeded to the next stage.
“The design of the STAR*D study reflects what is done in clinical practice because it allowed study participants to choose certain treatment strategies most acceptable to them and limited the randomization of each participant only to his/her range of acceptable treatment strategies. No prior studies have evaluated the different treatment strategies in broadly defined participant groups treated in diverse care settings.” (Emphasis added)
One of the key points of this study was that patience is needed to find the right combination for any one patient as individual responses vary widely.
The NIMH study showed that patient self-assessments of symptoms and responses could be considered reliable in assessing response to treatment.
More recently, there have been concerns about the pharmaceutical companies having undue influence in the management of depression. Mental health benefits companies have shown a tendency to prefer medication over talk therapy. A new bill passed to provide parity for mental health diagnoses and others is, at implementation time, meeting with resistance from payers, other news reports have said.
Depression treatment, for all but those with the mildest depression, is not easy nor easily paid for.
Consumer Reports published a new study today about people’s opinions of their depression treatment. The NIMH study—which was intended to provide specific treatment guidance which could be used in a variety of clinical settings—did not examine the role of talk therapy in depression treatment. It also was focused on identifying treatments which worked for patients whose symptoms could be brought into remission in each of four stages. Therefore, it included patients who achieved remission quickly but also included the most treatment-resistant depressive disorders.
Caution: Consumer Reports is not a peer-reviewed medical journal.
Population Sample: Both the NIMH study and the magazine’s survey based assessments on the patient’s or reader’s own assessment of what worked. Research has shown that patients are able to assess their functional improvement or the lack of it in a way clinicians can rely upon in general.
Sample size: For the NIMH study, participation broke out this way. “Thus, 2,876 “evaluable” people were included in level 1 results. Level 2 results include 1,439 people who did not become symptom-free in level 1 and chose to continue. Level 3 results include 377 people, and Level 4 results include 142 people.”
Consumer Reports surveyed 1,500 readers in a poll.
Clinical credentials: In the NIMH study, care-givers were physicians in primary and specialty settings. In the Consumer Report survey, reader reports of results from any licensed talk therapist results were included.
What is of the greatest interest in this Consumer Reports survey is that those surveyed benefited from almost any kind of therapy—medication or talk therapy. Moreover, the therapist could be an M.D., a Ph.D or a master’s level social worker. All got results for these readers.
“Americans prefer drugs to talk therapy for depression, with nearly 80 percent taking a pill for the condition, Consumer Reports said on Tuesday.
“The most popular class of drugs remain the so-called SSRIs such as Prozac, the group found. People found newer, pricier antidepressants less desirable because of side-effects.
“Patients benefited just as much from therapy — almost any kind of therapy, the consumer group found in its survey of 1,500 readers.
“Those surveyed said they improved just as much after seven or more sessions of talk therapy as if they took drugs and it did not matter if the therapist was a psychiatrist, psychologist or social worker.
Source: Reuters, June 1, 2010
Source: Consumer Reports, June 1, 2010
Citation:
“Nearly 80 percent of people who had been diagnosed with depression or anxiety were prescribed antidepressants.”
