Despite Successful Antidepressant Treatment, Despair Can Remain

While antidepressants can successfully treat depressive symptoms, despair can remain; and this may result in the patient not taking the medication any longer, according to a study that tbe journal, General Hospital Psychiatry.

For many in the study, feelings of hopefulness did not improve until several weeks, or even months, after depressive symptoms lifted, says lead author James E. Aikens, Ph.D., associate professor in the Department of Family Medicine at the University of Michigan Health System.

"The finding suggests that some patients may become unduly pessimistic and stop adhering to an already-helpful therapy," he notes. This finding is troubling, he says, because hopelessness is a strong risk factor for suicide.

573 patients from 37 practices suffering from depression were studied by Aikens and his team, and given either fluxotine (Prozac), paroxetine (Paxil), or sertraline (Zoloft). Patients were then reviewed one, three, six and nine months after treatment began. Patient response to medication was fast: 68% of improvement was achieved by the end of the first month, 88% by three months. Areas of major improvement were positive emotions, work functioning and social functioning.

There was little improvement recorded in head, back and stomach pain after the first month, and Aikens said that if these physical complaints persisted after the first few weeks of treatment, physicians should consider treatments that directly affect pain in depressed patients.

Where hopefulness was concerned improvement noted was more gradual, and Aikens recommended that physicians teach patients to recognize and fight the pessimistic thoughts that often accompany depression, and encourage patients to get involved in mood-lifting activities.

In addition to Aikens, authors were: senior author Amanda Sen, Ph.D., of the Department of Family Medicine, the Department of Statistics and the Center for Statistical Consultation and Research at the University of Michigan; Donald E. Nease Jr., M.D., of the Department of Family Medicine at the U-M Health System; Michael S. Klinkman, M.D., M.S., of the departments of Family Medicine and Psychiatry at the U-M Health System; and Kurt Kroenke, M.D., of Indiana University.

With hopefulness, however, the improvement was much more gradual. Physicians may want to consider cognitive-behavioral strategies, such as teaching patients to identify and challenge the pessimistic thoughts that usually accompany depression, and encouraging them to engage in activities that may improve their mood, Aikens says.

In addition to Aikens, authors were: senior author Amanda Sen, Ph.D., of the Department of Family Medicine, the Department of Statistics and the Center for Statistical Consultation and

Source: General Hospital Psychiatry, (January-February, 2008)

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