“The one, in my view, that would work in the long term is treating depression early, treating depression correctly, and treating depression non-selectively,” Dr Daniel Goleman said in 2013.


“Unfortunately depression is not treated well in the US. It’s a therapy that’s targeted in the short term. It’s inadequate in the long term.”


The US government supports a number of treatment programs to treat depression, which typically include therapy for depression, medication or both. One such program is offered through the Defence Mental Health Clinic at the National Defence Medical Centre in Seattle.


The five-year study had a dual goal:


To determine if depression treatment using medication for treatment is superior to depression treatment using medication alone


The analysis also looked at whether psychological treatments such as psychotherapy or cognitive behaviour therapy were more effective than medications for treating depression.


The study also measured the relationship between medication and treatment effectiveness.


What were the findings?


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Before the study began, patients filled out questionnaires about their depression, motivation and activities.


The researchers then selected 120 patients with depression who met the criteria to be part of the study. These patients were placed randomly in treatment groups according to the strength of their depression:


Fifty per cent of participants received antidepressants alone, which is considered the first-line treatment


Twenty per cent received antidepressants and psychotherapy alone, which is considered second-line therapy


Another 20 per cent received antidepressants and psychotherapy


The last 20 per cent received antidepressants and psychotherapy together, which is considered third-line therapy


On average, participants in the third-line therapy group received two antidepressants each week.


The overall diagnosis was assessed using self-reporting for depression. The patients were given an increase of one point to their depression score each time they received a depression diagnosis.


They also received a treatment score for treatment effectiveness of zero to 40, with zero indicating the therapy did not work for depression and 40 the therapy was superior to medication.


Among all patients, treatment effectiveness varied among patients:


The third-line therapy group scored the highest, with an overall treatment effectiveness of 40


The second-line therapy group scored the lowest, with an overall treatment effectiveness of 16


What were the key results?


Researchers found overall treatment effectiveness of 20 per cent for the third-line therapy group.


For the first and second-line therapies, treatment effectiveness ranged from 13 per cent to 29 per cent.


As treatment effectiveness increases for depression, the drugs typically take longer to work, and the number of antidepressants necessary to treat depression increases.


Experts have observed that depression patients who receive third-line treatment are on antidepressants for a longer period of time. The patients were also more likely to need several antidepressants to treat their depression.


Professor Malcom Ross, who also worked on the study, explained:


If we had used a different therapy, it would have been more likely to be effective, especially for the second-line therapy group.


In terms of psychological therapy for depression, the researchers found the treatment was better at treating depression symptoms. However, the researchers found there was no treatment effect.


The study showed that the medication alone was the most effective treatment.


It said:


Third-line therapy is suitable for patients with low depression severity and chronic depression, but is ineffective for patients with higher depression severity


The report concluded:


There are no treatment guidelines and no standard of care for third-line depression treatment.


Professor Ross explained the findings by saying:


Clinicians have a duty to evaluate the effectiveness of different treatments. But currently, the best course of action is based on trial evidence and clinicians have to make an appropriate judgement based on the disease and illness.


The research was published in the journal Psychiatry Research: Clinical Practice.


Overall, the researchers acknowledge the study was small and cannot be considered to have definite evidence about which treatment is best.


Professor Ross added:


We hope our results contribute to the development of better treatment guidelines for patients suffering from chronic depression.


Shirley Cramer is professor of mental health and wellbeing at the University of Oxford.


Find out more about the depression symptoms that indicate depression, including the possible symptoms that prompt people to take medication.


By Rachael Coles, Head of Health & Wellbeing, University of Oxford


This article was originally published on The Conversation. Read the original article.


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