Is there really a cure for depression
Out of Depression Faster: New Strategies for Using Antidepressants
Winston Churchill once used a "black dog" as a metaphor for his depression. Most people who suffer from this mental illness feel drained, sad and empty - others feel rushed and driven. Even if the disease was barely noticed in public for a long time, it has long been a widespread disease. Antidepressant drugs play a central role in their treatment. However, although numerous and proven antidepressants are available, the disease often turns out to be protracted and serious.
“Depression limits patients considerably in their lives. If the first steps in therapy do not work and medication has to be exchanged, this often leads to very long treatment times, ”says Professor Klaus Lieb, Director of the Clinic for Psychiatry and Psychotherapy at the Mainz University Medical Center. “In this situation, people often lose hope and the risk of suicide increases. That is why it is so important for us to develop new strategies with which we can help those affected more quickly. "
Wanted: the right time to change your medication
One way to achieve this is the complex and tedious development of new antidepressant agents. A second starting point is to optimize the strategies for using the proven antidepressants available today. This is exactly where the study on "Early Medication Change" (EMC), funded by the Federal Ministry of Education and Research (BMBF), comes in. It is the first meaningful randomized clinical study on this question.
It was previously believed that antidepressants were slow to work. Therefore, current guidelines recommend that a supposedly unsuccessful therapy should only be changed after three to four weeks. "An improvement in depressive symptoms can often be seen in the first 14 days of therapy," says associate professor Dr. André Tadić. As senior physician at the Clinic for Psychiatry and Psychotherapy at the Mainz University Medical Center, he coordinated the EMC study. “These early improvements predict the subsequent success of the treatment quite reliably. With rapid progress, a complete therapy success is likely after four to eight weeks. If, on the other hand, there is no improvement after two weeks, recovery cannot be expected in the following weeks with the same therapy. ”The EMC study is the logical consequence of these observations. She investigated whether, if the therapy was unsuccessful, changing the medication more quickly could achieve better results and shorten the patient's suffering.
New strategy accelerates the success of the treatment
The Clinic for Psychiatry and Psychotherapy at the Mainz University Medical Center led the study and carried it out, among other things, in cooperation with the Interdisciplinary Center for Clinical Studies (IZKS) in Mainz, which is also funded by the BMBF. Around 900 patients with moderate or severe depression took part. All received antidepressant therapy. In around 200 patients, there was no improvement in the first two weeks of treatment. They were divided into two groups and treated differently:
- In one group, the doctors replaced the unsuccessfully administered drug in the first two weeks of treatment with a new one (“Early Medication Change”). Even if this change did not improve the symptoms after two weeks, the therapy was reinforced with a second drug.
- In the second group, the medication ineffective after two weeks was continued for another two weeks after the start of treatment. The therapy was only changed after four weeks - as recommended by current guidelines.
In the group with an early drug change, patients recovered more quickly. They also showed better results in a number of other important aspects of therapy.
The EMC study showed that patients who show little or no improvement in their symptoms after two weeks of treatment with an antidepressant are very likely to need a therapy change in order to get well. "The study also shows how indispensable publicly funded - that is, independent of the pharmaceutical industry - clinical studies are for progress in medicine," says Lieb. “We hope that our results will reduce the duration of unsuccessful antidepressant treatments and thus the patient's suffering to a minimum. It must not be that people are treated with the same antidepressant for months if their condition does not improve. "
Great need for research
Unipolar depression is the most common type of depressive disorder. The World Health Organization (WHO) predicts that it will be the disease with the highest disease burden in industrialized nations by 2030; worldwide it is only exceeded by HIV / AIDS. The WHO forecast illustrates the urgent need to develop more effective treatment strategies.
In order to accelerate therapeutic success, Lieb and Tadić want to further develop strategies of "Early Medication Change" and test them in clinical studies. It is also important to identify new diagnostic markers - these should show even earlier whether an antidepressant therapy is effective or not.
Widespread disease depression
In Germany around four million people - that is five percent of the population - suffer from depression. This makes this disease, like high blood pressure or diabetes mellitus, a widespread disease. Depression is chronic in every fifth person and often ends tragically: 7,000 to 9,000 Germans take their own lives every year as a result of depression. The disease thus claims more victims than traffic accidents, drug abuse and AIDS.
Prof. Dr. Klaus Lieb
Clinic for Psychiatry and Psychotherapy
Mainz University Medical Center
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