As Depression Symptoms Improve With Antidepressants, Hopelessness Can Linger
People taking medication for depression typically see a lot of improvements in their symptoms during the first few months, but lagging behind other areas is a sense of hopefulness, according to new research from the University of Michigan Health System.
That means people with depression may still feel a sense of hopelessness even while their condition is improving, which could lead them to stop taking the medication.
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.
Aikens and his team studied 573 patients with depression from 37 practices. They were given an antidepressant, either fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft). They were assessed one, three, six and nine months after the treatment began.
Overall, patients’ depression responded rapidly to medication, with 68 percent of their improvement occurring by the end of the first month, and 88 percent by three months. The patients experienced the majority of their improvement in several areas during this time period, including positive emotions, work functioning and social functioning.
Improvements in head, back and stomach pain plateaued during the first month, with little improvement thereafter. Because of that, Aikens says, physicians may want to consider additional treatments that directly target pain in depressed patients if these physicial complaints persist after the first few weeks of treatment with antidepressants.
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.
The original study that tested antidepressants was conducted by Eli Lilly Inc. The current secondary data analysis was conducted by the authors, not the sponsor. Also, Aikens has served as paid consultant to Pfizer; Klinkman has served as a paid consultant to Wyeth Pharmaceuticals; and Kroenke has received honoraria from Pfizer, Eli Lilly and Wyeth.
General Hospital Psychiatry
Volume 30, Issue 1, January-February 2008, Pages 26-31
doi:10.1016/j.genhosppsych.2007.10.003 Copyright © 2008 Elsevier Inc. All rights reserved.
Psychiatry and Primary Care
Trajectories of improvement for six depression-related outcomesstar, open
James E. Aikens Ph.D.a, b, Corresponding Author Contact Information, E-mail The Corresponding Author, Kurt Kroenke M.D.c, d, Donald E. Nease Jr. M.D.a, Michael S. Klinkman M.D., M.S.a, b and Ananda Sen Ph.D.a, e
aDepartment of Family Medicine, University of Michigan, Ann Arbor, MI 48109-5708, USA
bDepartment of Psychiatry, University of Michigan, Ann Arbor, MI 48109-5708, USA
cDepartment of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-3002, USA
dRegenstrief Institute, Indianapolis, IN 46202-3012, USA
eDepartment of Statistics, and Center for Statistical Consultation and Research (CSCAR), University of Michigan, Ann Arbor, MI 48109-1070, USA
Received 10 August 2007; accepted 11 October 2007. Available online 27 December 2007.
Although depression treatment improves diverse outcomes, it is unclear whether these improvements are comparable in magnitude and timing. The objective was therefore to compare treatment-related improvements in depressive symptoms, work and social functioning, hopefulness, somatic complaints and positive well-being.
Secondary analysis of a large clinical trial of selective serotonin reuptake inhibitors for primary care depression. Depressed patients (n=573) from 37 practices from two primary care networks were randomized to fluoxetine, paroxetine or sertraline, and then followed naturalistically. At 1, 3, 6 and 9 months after treatment initiation, assessments were made of depressive symptom severity, social and work functioning, positive well-being, hopefulness beliefs and somatic complaints. Data were analyzed with linear regression modeling.
Although 68% and 88% of total mood improvement occurred by Months 1 and 3, respectively, improvement plateaued sooner for somatic complaints (P=.001 at Month 1), and more gradually for hopefulness [P (Month 1)=.015, P (Month 3)=.036]. Although magnitude of improvement was interrelated across outcomes, timing of mood improvement was unrelated to the timing of improvement in both somatic complaints and hopefulness. Improvement in somatic complaints was primarily attributable to improvements in head, back and stomach pain.
Work and social functioning, and positive affect improve synchronously with mood. Compared to mood, improvement in pain complaints peaks earlier, whereas improvement in hopefulness is much more linear over time. Because depression treatment response appears to be complex and multidimensional, a broader conceptualization of depression remission may be indicated.