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Depressed people do worse on
medications (Reuters) |
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According to a new look at past
antidepressant trials, up to a fifth of patients on Cymbalta and
similar medications may actually do worse than those given
drug-free placebo pills.
Researchers found that patients’ symptoms over the first couple
months of antidepressant use separated them into “responders,”
who got progressively better, and “non-responders,” who didn’t
improve with treatment but may still have suffered side effects.
However, “It’s difficult to say a priori who will be in which
group,” Ralitza Gueorguieva, the study’s lead author from the
Yale University School of Medicine in New Haven, told Reuters
Health.
The findings highlight the importance of identifying as soon as
possible which patients will and won’t respond to certain drugs,
her team said.
The researchers combined data from seven studies that randomly
assigned patients to receive Eli Lilly’s drug Cymbalta (known
generically as duloxetine), other antidepressants, or a placebo
pill for two months. Those trials involved a total of about
2,500 people with major depression.
People getting the placebo tended to report small, gradual
improvements in depression symptoms. On the other hand, those on
Cymbalta or another antidepressant fell into one of two
categories: most had steeper, steady improvements in depression
symptoms, but a sizeable chunk didn’t seem to get any better.
About four in five patients on all antidepressants were
responders. For Cymbalta in particular, about 84 percent of
patients improved and 16 percent did not.
Medication responders saw significantly bigger improvements in
their depression symptoms than patients assigned to the placebo.
Non-responders, however, did worse.
Differences between antidepressant responders and non-responders
were seen as early as a week or two into treatment, and the
researchers wrote in their Archives of General Psychiatry report
that initial improvements seem to predict who will have a better
outcome on Cymbalta, along with the other drugs.
“You know within the first couple weeks of starting a treatment
who’s the most likely to benefit because they’re already
starting to show improvement,” said Dr. Michael Thase, a
psychiatrist from the University of Pennsylvania Perelman School
of Medicine who wasn’t involved in the new study.
“The first few weeks are revealing, and obviously if the
patient’s getting worse instead of better, I would use that as a
strong indicator that this particular treatment isn’t likely to
work,” he told Reuters Health.
“I think this finding holds true for the antidepressants that
are most commonly used today,” he said of the gap between
responders and non-responders.
Thase pointed out that side effects of antidepressants, such as
stomach problems and poor sleep, could make some patients score
lower on measures of depression—perhaps explaining the worse
symptoms seen in non-responders compared to placebo patients.
He added that if patients don’t benefit from a first
antidepressant, they could still respond to a different type of
drug, although the chances fall with each successive treatment
attempt.
Another scientist said the latest research has been trying to
pick out certain patient characteristics—genetics or specific
depression and anxiety symptoms, for instance—that could help
determine who will end up in the responder category, and who
won’t see any benefit from individual drugs.
“If you can identify people who would be potential responders to
a particular medication...it would be a great, huge advantage
for the field,” said C. Hendricks Brown, who has studied
depression treatments at the University of Miami Miller School
of Medicine, but wasn’t linked to the new research.
Gueorguieva agreed. “Identifying variables that are associated
with response is a very important question that we haven’t quite
tackled,” she said.
One of the study’s authors is an employee of Eli Lilly and
another is on the company’s scientific advisory board.According
to a new look at past antidepressant trials, up to a fifth of
patients on Cymbalta and similar medications may actually do
worse than those given drug-free placebo pills.
Researchers found that patients’ symptoms over the first couple
months of antidepressant use separated them into “responders,”
who got progressively better, and “non-responders,” who didn’t
improve with treatment but may still have suffered side effects.
However, “It’s difficult to say a priori who will be in which
group,” Ralitza Gueorguieva, the study’s lead author from the
Yale University School of Medicine in New Haven, told Reuters
Health.
The findings highlight the importance of identifying as soon as
possible which patients will and won’t respond to certain drugs,
her team said.
The researchers combined data from seven studies that randomly
assigned patients to receive Eli Lilly’s drug Cymbalta (known
generically as duloxetine), other antidepressants, or a placebo
pill for two months. Those trials involved a total of about
2,500 people with major depression.
People getting the placebo tended to report small, gradual
improvements in depression symptoms. On the other hand, those on
Cymbalta or another antidepressant fell into one of two
categories: most had steeper, steady improvements in depression
symptoms, but a sizeable chunk didn’t seem to get any better.
About four in five patients on all antidepressants were
responders. For Cymbalta in particular, about 84 percent of
patients improved and 16 percent did not.
Medication responders saw significantly bigger improvements in
their depression symptoms than patients assigned to the placebo.
Non-responders, however, did worse.
Differences between antidepressant responders and non-responders
were seen as early as a week or two into treatment, and the
researchers wrote in their Archives of General Psychiatry report
that initial improvements seem to predict who will have a better
outcome on Cymbalta, along with the other drugs.
“You know within the first couple weeks of starting a treatment
who’s the most likely to benefit because they’re already
starting to show improvement,” said Dr. Michael Thase, a
psychiatrist from the University of Pennsylvania Perelman School
of Medicine who wasn’t involved in the new study.
“The first few weeks are revealing, and obviously if the
patient’s getting worse instead of better, I would use that as a
strong indicator that this particular treatment isn’t likely to
work,” he told Reuters Health.
“I think this finding holds true for the antidepressants that
are most commonly used today,” he said of the gap between
responders and non-responders.
Thase pointed out that side effects of antidepressants, such as
stomach problems and poor sleep, could make some patients score
lower on measures of depression—perhaps explaining the worse
symptoms seen in non-responders compared to placebo patients.
He added that if patients don’t benefit from a first
antidepressant, they could still respond to a different type of
drug, although the chances fall with each successive treatment
attempt.
Another scientist said the latest research has been trying to
pick out certain patient characteristics—genetics or specific
depression and anxiety symptoms, for instance—that could help
determine who will end up in the responder category, and who
won’t see any benefit from individual drugs.
“If you can identify people who would be potential responders to
a particular medication...it would be a great, huge advantage
for the field,” said C. Hendricks Brown, who has studied
depression treatments at the University of Miami Miller School
of Medicine, but wasn’t linked to the new research.
Gueorguieva agreed. “Identifying variables that are associated
with response is a very important question that we haven’t quite
tackled,” she said.
One of the study’s authors is an employee of Eli Lilly and
another is on the company’s scientific advisory board.
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