Depression severity predicts how well antidepressant drugs will work

Originally published in Insidermedicine

The benefits of antidepressant therapy increase with the severity of underlying depression, according to a meta-analysis published in the Journal of the American Medical Association.

Here are some guidelines for using second-generation antidepressants to treat depression from the American College of Physicians:

• Select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences

• Assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy

• Modify treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder

Researchers out of the University of Pennsylvania in Philadelphia conducted a meta-analysis of six randomized, placebo-controlled trial exploring the benefits of antidepressant medications in adults with depression. Overall, data from 718 patients were included in the analysis.

The difference in efficacy between antidepressant therapy and placebo varied substantially based on the severity of the depression at baseline. Among the patients with Hamilton Depression (HAM-D) scores below 23, antidepressant therapy offered only a small benefit over placebo. As the severity of the depression increased, so did the magnitude of superiority of active therapy over placebo. The difference in efficacy between active therapy and placebo became clinically significant once baseline HAM-D score reached 25.

Today’s research suggests that antidepressant therapy may only offer clinical benefit among patients with relatively severe forms of depression.

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