October 03, 2003

Martha Kerr

Oct. 3, 2003 (New Orleans) — More than 50% of patients who experience an episode of depression are likely to have a recurrence. Patients with three or more episodes of depression have an 80% to 90% likelihood of recurrent episodes. These statistics point to the importance of treating depression to the point of remission rather than just to the point of symptom relief, researchers at the University of Cincinnati told attendees here today at the American Academy of Family Physicians annual scientific assembly.

Marshall Hayes, DO, from the university's Department of Psychiatry, presented results of a meta-analysis of six studies involving approximately 2,000 patients with episodes of major depressive disorder. Recurrence is more likely with each episode of depression, Dr. Hayes reported. More than 50% will experience a recurrence within 10 years. Achieving and sustaining remission may decrease this likelihood, he stressed.

"Usually, patients are treated insufficiently," Dr. Hayes noted. "A kindling effect occurs when patients have repeated episodes of depression — to the point where life stressors are no longer triggers. The patient just gets depressed. We recommend continued treatment in these patients."

To ensure patients are in remission, Dr. Hayes has them complete the Beck Depression Inventory at follow-up visits. To meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, definition of remission, symptom relief must persist for at least six months.

"We'll use a single agent initially and maximize the dose to achieve symptom relief or until intolerance occurs. Then we'll switch to a different drug in the same class. If there is another family member who has been successfully treated for depression, I'll use the same drug and that typically works," Dr. Hayes told Medscape.

Steven Langdon, MD, from the Department of Family Medicine at the University of Cincinnati, noted that "Family physicians are far more likely to use selective serotonin reuptake inhibitors (SSRIs) than other classes of antidepressants. We feel far more comfortable with them. If the SSRI fails, then we are likely to refer that patient to a psychiatrist." Dr. Langdon was not associated with the study.

"SSRIs are a class of drugs, whereas other antidepressants tend to be classes unto themselves," Dr. Langdon said. "Hopefully, family physicians will become more comfortable with other agents, but I think I'm fairly representative of FPs."

Financial support for the study was provided by Wyeth Pharmaceuticals.

AAFP 2003 Scientific Assembly. Presented Oct. 2, 2003.

Reviewed by Gary D. Vogin, MD

Martha Kerr is a freelance writer for Medscape.


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