Long-Term Use of Antidepressants Prevents Relapse

High-risk may benefit from a year or more of medication, study finds

FRIDAY, Feb. 21, 2003 (HealthDayNews) -- While short-term therapy on antidepressants may clear up depression symptoms, people who have had more than one episode of the blues may want to stay on the drugs for a year or more to prevent a relapse.

That's the conclusion of a new study appearing in the Feb. 22 issue of The Lancet.

British researchers analyzed data from 31 other studies on antidepressant medication and found that, regardless of the type of antidepressant taken, staying on these medications for a year or more could cut the risk of having another depressive episode in half for those with a history of depression.

"[People with a history of depression] should not underestimate the continuing benefit conferred by antidepressants," says one of the study's authors, Dr. Guy Goodwin, chairman of the department of psychiatry at the University of Oxford. "This study shows that medicines go on working for at least three years and so patients taking them long-term are likely to continue to benefit."

Every year, more than 18 million Americans -- nearly 10 percent of the U.S. population -- suffer from depression, according to the National Institute of Mental Health. Almost twice as many women as men are affected by the disorder. Some of the symptoms of depression are a persistent sad mood, feelings of hopelessness, guilt, or worthlessness, loss of interest or pleasure in hobbies and activities, fatigue, insomnia or a change in appetite.

The Oxford researchers studied data from 4,410 patients in more than 30 randomized, placebo-controlled clinical trials. All of the participants in the studies had responded to antidepressant medication and then either continued the medication or were put on a placebo.

The studies included a variety of commonly prescribed antidepressant medications, such as tricyclics, selective serotonin reuptake inhibitors, and MAO inhibitors.

The researchers found that the rate of relapse for people taking the placebo (41 percent) was more than twice that of people who continued taking antidepressants (18 percent).

While not surprised by this information, Dr. Gerald Shiener, a psychiatrist at William Beaumont Hospital in Royal Oak, Mich., says it's good to see all the information about the length of treatment in one study.

"We've known for some time that depression is a recurring illness," says Shiener, who says that about half of all people who have one bout of depression will have another. He says that someone who has had two depressive episodes has about an 85 percent chance of having recurring depression throughout her life.

However, he adds, "The right help can be effective and help the illness from re-occurring."

People sometimes stop taking antidepressants because of unpleasant side effects, say Goodwin and Shiener. Other reasons people may stop, Sheiner says, are that they don't like to be reminded that they're ill, and having to take medication daily is a constant reminder; they start to feel better and become convinced they don't need the medication; or because depression is often accompanied by feelings of guilt or shame, they may feel that they don't deserve to be helped.

It's important for people who are depressed to remember that it is an illness, not a moral weakness, says Shiener. The typical depressive episode lasts 11 months, he says, so it's important to work with your doctor to find an effective treatment you can tolerate if you suffer from depression.

More information

To learn more about antidepressants, visit the United Kingdom's Royal College of Psychiatrists or the American Academy of Family Physicians.

SOURCES: Guy Goodwin, M.D., Ph.D., chairman, department of psychiatry, and professor, psychiatry, Oxford University, United Kingdom; Gerald Shiener, M.D., psychiatrist, William Beaumont Hospital, Royal Oak, Mich.; Feb. 22, 2003, The Lancet
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