For Depression: A Message of Hope

Posted on March 23, 2006

The New England Journal of Medicine has released two keystone studies on the treatment of major depression that are important to consumers, families and physicians.

Funded by the National Institute of Mental Health (NIMH), the studies represent the second phase of the Sequenced Treatment Alternatives to Relieve Depression clinical trials (STAR*D2). They provide long-term, "real world," comparative evidence that treatment with medication works for the most treatment-resistant depression.

STAR*D2 sends a clear message of hope to the 15 to 20 percent of people worldwide who struggle with depression at some stage in their lives. Treatment works. People do get better, to the point of complete remission, as long as they keep trying. The studies give consumers and doctors reasonable alternative strategies when one medication doesn’t work.

One in three consumers (33%) whose depression was resistant to initial treatment achieved remission - becoming not just better, but symptom-free -  when a second medication was added. One in four (25%) achieved remission after switching to a different anti-depressant.

Depression kills. Remission saves lives. Complete elimination of symptoms means a return to family, friends and productivity. The personal, social and economic benefits are vast.

Several important points should be recognized:

• STAR*D2 is part of a "Big Four" research series into the effectiveness of treatment of major depression, bipolar disorder, adolescent depression and schizophrenia, funded by NIMH. This comparative research is different from that conducted by private companies. It is an essential building block for a public research and treatment “infrastructure” that can lead to newer, better medications. It is essential that Congress continue funding NIMH so that NIMH can continue funding similar future studies, to keep the momentum going.
• The importance of switching or adding different medications underscores the importance of preserving broad access to a range of medications. Governors and state legislatures must now reconsider restricted formularies in Medicaid programs. Employers should review restrictions under managed care plans. Limiting choices to only two or three antidepressants will condemn too many individuals to life-threatening illness.
• Additional research is still needed. These studies did not directly compare the effectiveness of switching medication to adding one. We also need better understanding of the psychosocial forces surrounding depression and the relative effectiveness of psychotherapy, particularly in combination with different medications.