Depression Symptoms Ongoing Even With Optimal Treatment

Liam Davenport

February 22, 2016

Patients with major depressive disorder (MDD) continue to experience symptoms on a regular basis, even if they take their medications as prescribed, results of a new survey indicate.

The poll of US patients and healthcare providers revealed that more than 60% of patients have ongoing symptoms. The results also showed that in many cases, psychiatrists and primary care providers change patients' medication in a bid to find a more effective treatment.

"Physicians work closely with their patients to find the treatment plans that are most effective, but unfortunately, even when patients take their medication as prescribed, many still deal with MDD symptoms frequently," Gerald A. Maguire, MD, DFAPA, professor and chair of psychiatry and neuroscience, University of California, Riverside School of Medicine, said in a release.

"Patients should speak with their physicians about treatment plans and how often they are continuing to experience symptoms of MDD. New treatment advances may be required to better manage their symptoms," he added.

The research, which was conducted on behalf of Otsuka America Pharmaceutical, Inc, and Lundbeck, was published online February 11.

Impact on Daily Life

For the survey, Harris Polls selected 300 US adults older than 18 years who had been diagnosed with MDD, as well 150 psychiatrists and 152 primary care providers who treat adults with MDD.

Participants completed an online poll between April and May 2015. The poll consisted of questions that assessed the impact of MDD on their or their patients' lives and their experiences with antidepressant therapy, as well as demographic information. The patients were not required to be taking medication to participate; 10% were not taking medication at the time of the survey.

The results indicated that 89% of patients who were currently taking medication were taking their drugs exactly as prescribed; 56% reported that MDD was their most serious health concern.

Moreover, 61% of patients said they had to deal with MDD symptoms at least weekly. Patients also reported taking an average of 1.8 days off from work or school because of illness during the past month. They reported being unable to complete a daily living task, such as cooking, cleaning, or paying bills, an average of 6.3 days during the past month, and they missed a social event an average of 2.4 days during the past month.

Among the 52% of patients who were taking medication and who reported being satisfied or very satisfied with their therapy, a substantial number reported ongoing symptoms; 42% reported experiencing symptoms at least once a week, and 26%, several times a week.

The survey suggested that physicians change their patients' medications on a regular basis to find the best therapeutic option; 70% of psychiatrists and 54% of primary care providers changed their patients' treatment at least once a year.

Ongoing Symptoms Common

R. Hamish McAllister-Williams, MD, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom, who was not involved with the study, said that ongoing MDD symptoms are "very common," adding that patients have "some response, but they don't have full resolution of symptoms."

Speaking to Medscape Medical News, Dr McAllister-Williams agreed that patients often end up having their medication changed every year, which can happen for a number of reasons.

"It can occur because somebody has got ongoing symptoms. These are relatively mild but ongoing symptoms, and they're hunting for an antidepressant that is going to make all the difference and sort everything out. That may or may not be possible.

"Often, it is a situation that their current treatment has not been as well optimized as it might have been, either because they're not on an adequate dose of the drug or they may be better, actually, looking at adding a second medication to their antidepressant, rather than just constantly switching antidepressants," he said.

Another reason patients may have their medication switched, said Dr McAllister-Williams, is that they initially respond to treatment but then become unwell again.

"[Switching] might not actually be a good thing, because they may be switching from a medication that they are at least making a partial response to," he said.

"Again, it's a case of, Can that treatment be optimized? Can the dose be increased? Can something else be added in to lead to a fuller resolution of symptoms?"

For Dr McAllister-Williams, a two-pronged approach is required to help improve management of MDD symptoms.

"We struggle to effectively treat some patients' depression, and so further treatment options would be very welcome. However, I also believe that what we have is often suboptimally used.

"That would be my big take on this whole survey. I don't think it is just that we need more medication, I think that it is also that we need to use the current medication better."

Side Effects a Big Issue

The survey also found differences in opinion between patients and healthcare providers regarding the impact of side effects and the need for novel medications.

Specifically, 77% of psychiatrists surveyed and 69% of primary care providers reported being frustrated with the side effects their patients experienced, whereas only 45% of patients so responded.

Of the psychiatrists, 73% thought that there were not enough medication options available that worked well enough to relieve their patients' symptoms, compared with 54% of primary care providers and only 40% of patients.

Dr McAllister-Williams said that these findings were not "particularly surprising" and that the differences between physicians and patients were not "that big a deal."

"More doctors are saying we need more, better medications than the patients, but the doctors are always going to be in a better position to have an overview of the totality of treatments than a patient, so it's not surprising that the doctors are more likely to be saying that," he said.

Dr McAllister-Williams added that it was noteworthy that more physicians said they had a problem with side effects than did patients. This highlights the fact that the patients who responded were a "highly unusual group," insofar as 90% were taking their medication as prescribed.

"That's way higher than reality if you go out and randomly select a group of patients," he pointed out. "If that is true, you're getting patients who are adherent to their medication, and they're probably adherent to the medication because they have a relatively low level of side effects compared to the average patient.

"We know that side effects are an important factor in terms of nonadherence to medication, and therefore people becoming unwell again. Side effects are a big, big issue," he concluded.

The Living With MDD survey was conducted by Harris Poll on behalf of Otsuka America Pharmaceutical, Inc, and Lundbeck. Dr McAllister-Williams has disclosed no relevant financial relationships.

Source: Living With Major Depressive Disorder. Full text

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