Less May be More in the Management of Depression

A national study just published in the American Journal of Psychiatry says taking two medications for depression does not speed up recovery.

Although previous studies have suggested that combination therapy may be more effective than monotherapy, researchers at UT Southwestern Medical Center have now shown this is not the case. The condition, which affects approximately 19 million Americans each year, is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a long period of time. While the exact cause of depression is not known many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person’s life.

The Combining Medication to Enhance Depression Outcomes, studied 665 patients aged 18-75 with major depressive disorder. It randomized patients into 3 groups who were then prescribed FDA approved antidepressant medications.

After 12 weeks of treatment, remission rates were similar across the three groups: 39%, 39% and 38%, respectively. Response rates were  about 52% in all three groups. After seven months of treatment, remission and response rates across the three groups remained similar, but side effects were more frequent in the third group.

These results show that, “Clinicians should not rush to prescribe combinations of antidepressant medications as first-line treatment for patients with major depressive disorder,” said Dr. Madhukar H. Trivedi, Principal Investigator of the study  and Professor of Psychiatry and Chief of the Division of Mood Disorders at UT Southwestern.The clinical implications are very clear – the extra cost and burden of two medications is not worthwhile as a first treatment step,” he concluded.

The next step is to study biological markers of depression to see if it is possible to predict response to antidepressant medication and, thus, improve overall outcomes.

Prozac Pilots take to the Happy Skies

Flying in the US just got a whole lot easier…at least for pilots!

The US Federal Aviation Administration (FAA) has lifted a 70 year old rule that banned pilots from taking antidepressants because of the risks of sedation. The ban had endured because earlier generations of antidepressants caused side effects, such as drowsiness and seizures.  However, a panel of medical experts for the FAA found during two years of research that newer versions don’t cause side effects in everyone. When they do occur, they tend to subside over time.

This policy turnaround means that pilots taking selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft) citalopram (Celexa) and escitalopram (Lexapro) or their generic equivalents and who show success controlling their depression for 12 months, without side effects that could pose a safety hazard in the cockpit, will be able to seek permission to fly.

This rule change may benefit up to 10,000 grounded pilots.  It also includes a degree of amnesty for pilots who have lied about their diagnosis and treatment on medical certification forms. Previously, airline and other pilots who suspected they were depressed but wanted or financially needed to fly faced a choice: seek no medication for treatment, because doing so would disqualify them, or self-medicate and lie about it on a required medical certification form.

The National Institute of Mental Health estimates that about 9.5 percent of people 18 and older suffer from a mood disorder. A 2009 study by Columbia University showed that as many as 10% of Americans were taking antidepressants. FAA officials assume the percentage is about the same among pilots but has no hard numbers because the ban gave pilots a disincentive to report depression or treatment.

”We need to change the culture and remove the stigma associated with depression,” said an FAA official. ”Pilots should be able to get the medical treatment they need so they can safely perform their duties.”

SRxA’s Word on Health wonders if this will mean fewer delayed flights or more happy flight crews. What do you think?