I just wanted to write a quick follow-up to the two studies published earlier this week in the New England Journal of Medicine on the STAR*D research initiative.
A lot of the news stories written since these results were published suggest a very positive view of the study. For instance, the Associated Press’s medical writer suggested:
Up to one-third of those who added or changed medicines recovered from the crushing illness that is America’s top mental health problem, researchers said.
This is good news by itself, but the bigger picture is even more encouraging, doctors say. When viewed with earlier results, the new findings mean that roughly half of people who suffer from depression can get over it — not just improve their symptoms — with adequate medication.
But this kind of statement is really clouding the picture of what the current two studies show — that two-thirds of patients who try at least 2 different antidepressant medications over the course of 6+ months still do not find significant clinical improvement in their symtpoms. Six months and little improvement.
Doctors have long known — and have long done — what these studies are showing; using trial-and-error practice, physicians go through a number of antidepressants until they find one that works for an individual. They usually don’t wait 12 or 14 weeks like these studies did, but the studies do show that it is probably beneficial to do so since some people may not feel the effects of the medications until after that time.
Of course, with such a narrow emphasis on medication-only treatment of depression, these results are not surprising. There are a multitude of other studies from the past two decades that show that this is not the best standard of care for depression — medications combined with psychotherapy is. It would be interesting to see the results of a modern, large-scale study that examined such a combination.