If you're on an antidepressant and it’s not working, don’t give up on it: You may need a higher dose, a longer duration of therapy, a different antidepressant altogether, or a combination of medications. That’s the important lesson to learn from a large, six-year, four-step government study called the Sequenced Treatment Alternatives to Relieve Depression trial, or STAR*D. In fact, the researchers found that systematically trying these treatment options can lead to a remission in symptoms in up to half of severely depressed, treatment-resistant patients.

The STAR*D study, which looked at the use of popular antidepressants in people with chronic depression (lasting, in some cases, 15-16 years), is the first to provide "real world" scientific data on what to do when someone doesn't respond to a particular antidepressant, has severe depression, or suffers from multiple mental and physical ailments. These types of treatment-resistant patients are not typically included in antidepressant drug trials sponsored by pharmaceutical companies.

Here are nine important take-home messages from the STAR*D study:

• One antidepressant treatment does not fit all. You may need to try several medications to find a drug regimen that works for you. What fits one person may not fit your particular biology.
• Persevering through several different treatment attempts, as arduous as that may be, can improve results for many people.
• At standard doses of the most commonly used class of antidepressants - selective serotonin reuptake inhibitors (SSRIs) - 30 percent of patients with severe depression achieve remission with the first medication prescribed.
• It often takes 12 weeks to achieve an adequate response to an antidepressant, not the standard four to eight weeks that most doctors and mental health specialists were previously using to guide decisions.
• If the first choice of antidepressant does not provide adequate symptom relief, switching to a new drug is effective about 25 percent of the time.
• Switching from one SSRI to another is almost as effective as switching to a drug from another class.
• If the first choice of an antidepressant does not provide adequate symptom relief, adding a new drug while continuing to take the first medication is effective in about one-third of people.
• For people who don’t respond to first-line therapy with an SSRI, adding a second drug to the SSRI drug regimen appears to be slightly better than completely switching medications.
• For those who don't respond to switching to a new antidepressant or adding a second drug, trying a third medication can still help about one in five people.
  

Reprinted with permission. For further information: John Hopkins White Paper: Depression and Anxiety 2008, Dr. Simeon Margolis, MD, PhD, June 2008.