Antidepressants May Not Work for Those with Depression Plus Chronic Illness

People who struggle with both depression and chronic kidney disease are highly unlikely to benefit from typical antidepressant drugs, according to a new study published in the Journal of the American Medical Association (JAMA).

The new findings add to the growing evidence that commonly prescribed antidepressants are ineffective in people facing both depression and a chronic medical disease. In fact, previous research has found that depressed people who also have asthma or congestive heart failure also do not benefit from traditional antidepressants.

These findings raise a critical question of whether doctors should start making widespread changes in how they treat the millions of depressed Americans who suffer from chronic medical diseases. Experts at the O’Donnell Brain Institute in Texas say there is enough evidence to do so now.

“There is little justification in prescribing an antidepressant that will not work and will only cause side effects,” says senior author Dr. Madhukar Trivedi, director of the Center for Depression Research and Clinical Care, part of the Peter O’Donnell Jr. Brain Institute at the University of Texas (UT) Southwestern Medical Center.

“We should go back to the drawing board to understand the brain changes involved in these subtypes of depression.”

Nearly half of Americans live with a chronic medical condition, ranging from cancer and dementia to arthritis and asthma, according to the Centers for Disease Control and Prevention. Many of these patients also have major depression, including more than half of Parkinson’s patients, 41 percent of cancer patients, and more than a quarter of those with diabetes.

Doctors and patients should take these statistics into account when treating cases of major depression, says Trivedi, professor of psychiatry and holder of the Betty Jo Hay Distinguished Chair in Mental Health and the Julie K. Hersh Chair for Depression Research and Clinical Care.

Trivedi says both doctors and patients should be aware that standard antidepressants may not work and to be ready to try alternatives if routine monitoring of symptoms and side effects show another strategy is needed.

Trivedi, who led the Star*D studies that established widely accepted treatment guidelines for depressed patients, has recently made progress on developing a blood test that can determine in advance which antidepressants are more likely to work for specific subgroups of patients.

He also notes a range of other therapies that have proven effective for patients who don’t respond to initial treatments, including exercise, psychotherapy, ketamine, electroconvulsive therapy, and neuromodulation with magnetic stimulation.

Source: UT Southwestern Medical Center