Table of Contents
Volume 2, Issue 1 January, 2016
By the Numbers
Antidepressant efficacy in “major depressive disorder”
Given the above articles, what should you tell your patients regarding the probabilities of responding to “antidepressants” for major depressive disorder (MDD)?
Here are some statistics to remember and to cite with patients based on the STAR*D study. These numbers apply to standard monoamine agonists (antidepressants) used to treat major depressive disorder (MDD):
- Combining two monoamine agonists, or augmenting them (with lithium or thyroid hormone) is similar in efficacy to switching from one monoamine agonist to another.
- With the first monoamine agonist used to treat the first acute depressive episode, the likelihood of clinical response is about 50%.
- With the second monoamine agonist used to treat the first acute depressive episode, the likelihood of clinical response again is about 30%.
- After two failed trials of monoamine agonists for an acute depressive episode, the likelihood of response with a third or fourth agent (even adding lithium or MAOI) is cut in half to about 15%.
- Of those who respond acutely to a monoamine against for an acute depressive episode, the likelihood that they will stay well for a year staying on the same medication is 50% or less.
- Separate from efficacy, about 20-30% of patients will not be able to tolerate side effects in each antidepressant trial.
In short, using multiple monoamine agonists, about 2/3 of patients will eventually respond for the acute depressive episode.
- However, half of those patients will relapse within a year. Thus using multiple monoamine agonists, only about 1/3 will respond and stay well long-term.