Which of these treatments is most effective?  This is a question that doesn’t always have a clear answer.  Antidepressants have become the most frequently prescribed drug in doctor’s offices and outpatient clinics today.  In fact, between 1996 and 2005 the number of people in the United States taking antidepressants has doubled in size.

In a recent study, “Psychotherapy Versus Second-Generation Antidepressants in the Treatment of Depression”, researchers attempted to find a more clear answer to this frequently asked question.  This study when compared to past research focused more on comparing the “newest” drugs (i.e. Paxil, Zoloft, and Prozac) to psychotherapy administered by a “qualified” provider.  A majority of previous studies were comparing older drugs to psychotherapy which left an incomplete picture of the comparative effectiveness.

This study was a meta-analysis, meaning they looked at data from 15 studies of similar topics.  In the process of choosing these 15 they had to eliminate studies that were using inadequate treatment methods. This would include studies that included untrained psychotherapists or variables that affected treatment quality such as:  switching of treatments, changing of dosages of medication and/or changing frequency of psychotherapy.  Another factor taken into consideration was the level of depression of the participants.  Depending on severity of depression (mild, moderate, or severe) outcomes and effectiveness of medication and psychotherapy may vary and treatment recommendations may differ.  To improve accuracy this study focused only on participants that were diagnosed with major depressive disorder.

The result of this study found that psychotherapy can be just as effective in the treatment of depression when compared to the newest of antidepressant medications. It was also noted that in the long run psychotherapy showed slightly better results.

So the question is; did they come up with a clear answer?  When comparing risks, benefits, and cost the course of treatment is ultimately up to the individual and their providers.  Some questions to discuss with your doctor might include:

• How severe are my symptoms? How long have I experienced these symptoms?  In what ways do they impair my goals for my health?  Other research has indicated that anti-depressants are most effective for depression that is severe and/or chronic.
• Are their side effects that are more concerning to me?
• What are barriers to me following a treatment?  Can I remember to take medications as directed?  How will I get to appointments for therapy?  Do I have a plan for what to do if I relapse?

We still need more research to be completed that focuses on the effectiveness of these treatments.  Depression today is the fourth leading cause of disability in the United States and it is predicted to be the second by 2020.  It is essential for people with mental illnesses to understand the facts so they can make educated decisions with their doctors about which treatments are most suitable to their specific needs.

This post was written by MHAM Intern Jahna Sandkamp.

A study published online in the Proceedings of the National Academy of Sciences, suggests that anti-inflammatory drugs may decrease the effectiveness of SSRI antidepressants. Researchers at the Fisher Center for Alzheimer’s Disease Research at The Rockefeller University found that mice that were treated concurrently with SSRI antidepressants and anti-inflammatory drugs had diminished behavioral responses compared to mice treated with SSRI antidepressants alone.  To see if this finding had the same effect on humans, the researchers examined data extracted from the completed National Institute of Mental Health funded STAR*D study. The findings from the STAR*D data showed that individuals that were depressed and taking an SSRI antidepressant and an anti-inflammatory drug were less likely to have their symptoms relieved (40%), compared with individuals that were depressed and taking an SSRI depressant, but not taking an anti-inflammatory (54%).

Experts caution that this is a preliminary study and further studies need to be done. Individuals should not change their medication regimen based upon these recent findings, but should follow the advice of their prescribing physician.

By Brett Dumke, Education Coordinator

In a recent article in the journal of Preventing Chronic Disease, published by the Centers for Disease Control and Prevention (CDC), the authors stressed the critical role of primary care providers (PCPs) in “bridging mental health and public health.”   With the shift of care from mental health specialists to primary care, mental health delivery within these settings can provide a central focus on prevention from early detection, and effective continuation of care. But as the article suggests, time constraints and financial disincentives to treat mental disorders limit the ability for PCPs to provide high-quality care for these types of health conditions.  Implementing an integrated or collaborative approach for PCPs can help ensure that high standards of care can be achieved.

One such approach has been implemented right here in Minnesota and is receiving national recognition. Leading the way for improving depression care in the primary care setting is the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) program. Based upon the “IMPACT” study, the program was developed by the Institute for Clinical Systems Improvement (ICSI) and supported by members representing area heath plans, medical groups, patients, employer groups, and purchasers. The program involves a collaborative effort involving the primary care physician, consulting psychiatrist, care manager, and other mental health specialists.  The care manager plays a pivotal role in managing the essential components of the program for each patient, while the patient has an active part in determining his or her care.

So far, the success of the program is encouraging. According to the ICSI website, of the participants that have been active in the program for six months, “43% are in remission, and an additional 17% have seen at least a 50% reduction in the severity of their depression. These results are 5-10 times better than for patients with depression treated under  ‘usual’ primary care.”  Along with effective treatment results, the initial cost of treatment under programs like this can expect to be offset by substantial long-term cost savings. To track the effectiveness of this program the National Institute of Mental Health (NIMH) has provided a five-year grant to HealthPartners Research Foundation.

For more information on who is eligible for this program and what clinics are participating in this program, visit the ICSI website.