Posted by Mark H. on November 27, 2002, at 18:43:45
In reply to Update on hard to treat depression strategies, posted by Bill L on November 27, 2002, at 13:32:31
The cited article states: "At least eight weeks at a full therapeutic dose is necessary to evaluate the efficacy of an antidepressant (O'Reardon and Amsterdam, 2001), and treatment must continue for an additional four to five months (American Psychiatric Association, 2000)."
Fortunately, these two statements are completely untrue for many of us who have suffered from treatment-resistive depression and have found effective relief with the right medications during much shorter trial periods.
Unfortunately, there are doctors who will assume they are doing the right thing by following the advice of this article, while their patients become progressively worse during the 2-1/2 months or more that it takes to reach and maintain the full therapeutic dosage for an "adequate trial."
Further, if an antidepressant works for someone who has treatment-resistive depression, then of course it is going to be continued, not just for months, but possibly for years. TRD is, by definition, a long-term chronic illness. If an antidepressant doesn't work, however, continuing it for an additional four to five months past an already miserable trial period is inexcusable.
I can only speak for myself as a patient, but here is what worked for me:
1.) If a medication makes my depression worse, I won't continue to take it. My experience has been that giving it more time only further deepens my depression.
2.) I won't continue to take any medication that helps initially but poops out after a few days or weeks. Again, my experience has been that giving it more time does not improve my depression.
3.) Anti-depressant and adjunctive medications that work for me generally work very rapidly, with significant relief coming either immediately or within a few days of reaching therapeutic dose. These are also the same medications most likely to continue to be of benefit to me over an extended period of time (5 years and counting at this writing).
I realize that different people react to medications differently, and I caution the reader not to generalize from my experience. However, I think it is far more humane, effective and sensible to try several different antidepressant medications and adjunctives in relatively shorter rotations, looking for those that provide early relief (or at least some improvement), before resorting to long-term trials for major treatment-resistive depression.
It's also important to recall that most occurrences of "ordinary" depression resolve on their own within two to six months, which might account for the efficacy of those medications that appear to be effective only when given an "adequate" trial period and then are continued for an additional four to five months.
The concept of the "adequate trial" in TRD may give physicians some comfort and relief from the anxiety of dealing with patients who do not improve immediately -- and for some patients, long-term trials will be necessary -- but for a significant number of patients, it may only needlessly prolong their suffering.
With kind regards,
Mark H.
poster:Mark H.
thread:129604
URL: http://www.dr-bob.org/babble/20021127/msgs/129631.html