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Doctor-Patient Teamwork Can Beat Depression

Sometimes, success doesn't come until third or fourth therapy, study finds

WEDNESDAY, Nov. 1, 2006 (HealthDay News) -- More than two-thirds of people with major depression can become symptom-free if they work with their doctors and try various treatments -- such as antidepressants or cognitive therapy -- to determine which ones work best for them, a landmark study finds.

"The good news is that two-thirds of people can be relieved of their depression if they hang in there for up to four treatment steps. That's pretty significant for a tough illness," Dr. A. John Rush, vice chairman of clinical sciences and a professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas, said in a prepared statement.

"The not-so-good news is that when more steps are needed to get to remission or meaningful improvement, the higher the risk is for having a return of the depressive episode or a relapse," he said.

His team's final round of findings are published in the November issue of the American Journal of Psychiatry.

The study, known as STAR*D, included nearly 3,700 patients treated at 41 primary-care and psychiatric clinics across the United States.

Of the patients in the study who worked with their doctors and tried various therapies, 67 percent achieved full remission of depression symptoms by the end of one to four treatment steps, according to results from the six-year study, funded by the U.S. National Institute of Mental Health.

All the patients initially received the same antidepressant medication. Those who didn't respond to or couldn't tolerate the medication were encouraged to move on to the next treatment steps, where they were divided into various groups that received treatments including cognitive therapy alone or in combination with medication, as well as several different antidepressants used alone or in combination.

Patients' chances of achieving remission were higher after the first and second treatment steps (37 percent and 31 percent, respectively), than after the third and fourth steps (14 percent and 13 percent), the study found.

Patients who did improve or reach remission in fewer treatment steps had lower relapse rates during a yearlong follow-up than patients who had to go through more steps to improve or achieve remission.

More information

The American College of Physicians has more about depression.

SOURCE: University of Texas Southwestern Medical Center, news release, Nov. 1, 2006
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