Survey of Patients With Depression Finds Many Say Antidepressants Unhelpful

A survey of people living with depression seeking information about their perspectives and experiences living with the disease found that even though most took antidepressants, 42% of patients did not find them helpful, according to a poster presented at Psych Congress 2018.

The online survey was given between December 2017 and March 2018 via the website, newsletter, and social media platforms of Depression and Bipolar Support Alliance (DBSA), a patient support group. The patient perspectives of disease, overall wellbeing, and treatment outcomes are key to understanding the challenges that come with their disease, according to the authors.

Of the 435 participants, 83% were female, the mean age was 44, and most reported moderate depression (43%). Participants were included in the survey if they had a diagnosis of major depressive disorder (MDD), but excluded if they had both MDD and bipolar disorder.

The survey sought to gain an understanding of the experiences, feelings, health-related quality of life (HRQoL), and overall wellbeing of patients, and to see how a clinical measure of depression (the Patient Health Questionnaire-9 [PHQ-9]) correlated with patients’ self-reported resiliency, HRQoL, wellbeing, and self-perceived depression.

In addition to the PHQ-9, patients were also asked to use other measures, including the Short Form 12-item (SF-12) measure of HRQoL, the World Health Organization 5-item (WHO-5) measure of overall wellbeing, and the Connor-Davidson Resilience Scale (2-item version; CD-RISC2) measure of resilience.

The mean duration of depression was 25.2 years, 69% reported physical pain, and 52% reported that over the past 2 weeks they had lost interest in doing things on more than half of the days.

Most patients don’t get a complete response from medication, noted Amy K. O’Sullivan, head of health economics and outcomes research at Alkermes, which funded the study.

In one study, between 50% and 70% of patients with depression experienced only partial response to medication. Only 30% of patients achieved complete response. In the Sequenced Treatment Alternatives to Relieve Depression study (STAR*D), the landmark trial run by the National Institute of Mental Health, more than half of patients failed to achieve remission after first-line therapy, and about 70% did not achieve response after second-line treatment.

In the survey, among those currently using prescription medications, the most common therapy classes used were selective serotonin reuptake inhibitors (48%), dopaminergic/nonadrenergic agents (34%), serotonin and norepinephrine reuptake inhibitors (33%), and atypical antipsychotics (22%).

While 78% of participants take medications for depression, only 42% of these find them helpful. People living with depression reported problems coping with routines of everyday life, managing symptoms, and a sense of failure in being self-sufficient.

O’Sullivan said the survey results line up with these earlier study results and show the difficulty that patients face.

“What does that mean for their life?” she asked. Also, it raises the question, “what are they looking for in a treatment?”

Interestingly, the wellness strategy seen as most helpful by patients was getting enough quality sleep (76%) followed by playing with a pet (59%), or getting exercise (58%).

The number one desired improvement patients wanted from their depression treatment was improvement in emotional well-being. The symptom improvement patients ranked first was a reduction of suicidal thoughts and feelings.

“The take home from this is that we have a long way to go when treating for depression to a point where we can make a difference,” said O’Sullivan.

Reference

O’Sullivan AK, Benson H, Partham A, et al. Perspectives and experiences of individuals living with depression: severity of condition, wellbeing, and quality of life. Presented at Psych Congress 2018, October 25-28, 2018, Orlando, Florida. Poster 129.