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Relapse from antidepressant medication




A new study by Rhode Island Hospital scientists indicates that a relapse during antidepressant continuation therapy may be due to a relapse in patients who were not true drug responders. The loss of drug response may be due to loss of placebo response (a positive medical response to taking a placebo as if it were an active medication.). The study was reported in the recent issue of the Journal of Clinical Psychiatry.



Relapse from antidepressant medication

Historically, the therapy of depression is divided into three phases initial/acute, continuation and maintenance. During the initial phase, the goal is to reduce symptoms and psychosocial impairment. During the continuation phase, commonly six months to one year after initial therapy response, the goal is to maintain the gains and prevent a relapse. In the maintenance phase, which occurs after a sustained period of improvement, the goal is to further maintain the gains and prevent recurrence of the disorder.

Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at the Warren Alpert School of Medicine at Brown University, is the papers lead author. Zimmerman, along with his colleague Tavi Thongy, MD, also of Rhode Island Hospital and Brown University, conducted a meta-analysis of continuation studies of new generation antidepressants that began as placebo-controlled acute phase studies. Treatment studies of depression have observed that approximately 50 to 65 percent of patients respond to medicine and that approximately 25 to 35 percent respond to placebo.

Past studies have indicated that many patients who respond to therapy in the initial phase experience a relapse or recurrence despite ongoing pharmacotherapy during the two latter phases of therapy. This return of symptoms is often interpreted as a loss of efficacy of antidepressant activity, and is referred to as tachyphylaxis or the poop-out effect.

Zimmerman says, When a patient improves after being prescribed an antidepressant medicine you do not know if they got better because of the medicine or because they had a placebo response.

The scientists used formulas developed by Quitkin and his colleagues more than a decade ago to calculate the relapse rate attributable to relapse in presumptive placebo responders. Our study suggests that the return of symptoms despite ongoing therapy during the continuation and maintenance phases of therapy may not represent a loss of drug effect because the patient may not have experienced a true drug response in the first place.

Zimmerman also notes, While our conclusion is limited to the continuation phase of therapy, our results suggest that these findings probably also apply to the maintenance phase of therapy.

The scientists note that these findings are not inconsistent with conclusions that continuation and maintenance studies of antidepressants have clearly established the benefit of ongoing therapy beyond the acute phase.


Posted by: JoAnn    Source




Did you know?
A new study by Rhode Island Hospital scientists indicates that a relapse during antidepressant continuation therapy may be due to a relapse in patients who were not true drug responders. The loss of drug response may be due to loss of placebo response (a positive medical response to taking a placebo as if it were an active medication.). The study was reported in the recent issue of the Journal of Clinical Psychiatry.

Medicineworld.org: Relapse from antidepressant medication

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