An eagerly awaited landmark study published in the American Journal of Psychiatry this week makes the point quite clearly. Researchers followed 2,876 depressed patients at 41 different clinics while they were treated with Celexa (citalopram) - one of the best-selling depression medications, and a close chemical cousin of drugs like Zoloft, Prozac, Paxil, and Lexapro.
According to researchers, after 10 weeks of treatment:
Remission rates were 28% [based on clinicians' ratings] and 33% [based on patients' ratings].
This means that fewer than 1 in 3 patients recovered on Celexa, regardless of whether we look at the patients' own ratings of their symptoms or those of their clinicians.
It gets worse.
Patients in this study got much better care than the vast majority of patients "in the real world." They saw their doctors every couple of weeks - much more frequently than almost any insurance plan will cover. Their doctors also carefully evaluated medication levels at each visit, and increased dosage if the meds didn't seem to be producing an adequate response at the initial dose (again, this doesn't happen as efficiently in real world settings). Thus, by the end of the treatment period, the average dose was about 50mg per day - a higher dose than most patients will ever take (typical starting dose is 20mg).
Finally, the study's 28% response rate is actually an over-estimate, since it excludes the many patients who quit taking the meds right away (i.e., before they completed their first followup evaluation) as well as those who were switched by their doctors to a different drug for any reason (e.g., intolerable side effects).
Bottom line: The great majority of patients who take antidepressant medications do not experience a complete and lasting cure of their depression. This is why, for example, the epidemic of depression in the U.S. keeps getting worse (the lifetime prevalence of depressive illness is now nearly 25%) despite the millions of prescriptions dispensed each week.
I truly wish it were otherwise. And if you happen to be one of those who have benefited enormously from taking an antidepressant medication (as a practicing clinician, I've seen many), then know that I rejoice with you . . . if only it happened more often.
In posts to follow, I'll discuss what the research literature has to say about more effective and enduring treatments for depression.