The benefits obtained from antidepressants may vary according to the severity of the patient's depression, says a new article appearing in the January 6, 2010 issue of JAMA, and they may provide little benefit at all for those with mild to moderate depression.

Jay C. Fournier of the University of Pennsylvania and his colleagues conducted a meta-analysis to estimate the benefit of antidepressant treatment vs. placebo across a wide range of initial symptom severity in patients with depression, combining data from six large-scale, placebo-controlled randomized trials including 718 adult patients.

The authors found that the efficacy of antidepressant treatment varied considerably and was dependent upon the severity of symptoms. True drug effects (defined as an advantage of antidepressant treatment over sham treatment with a non-drug placebo) were non-existent to negligible among patients with mild, moderate or even severe baseline symptoms. They were, however, large for patients with very severe symptoms.

"What makes our findings surprising," say the authors, "is the high level of depression symptom severity that appears to be required for clinically meaningful drug/placebo differences to emerge," especially since the majority of patients receiving antidepressant treatment appear to have depression below these levels.

Efforts should be made, the authors conclude, to clarify to clinicians and patients that whereas antidepressants can have a substantial effect for those with more severe depression, there is little evidence to suggest that they give much benefit for those with less severe depression.

Many adults in the U.S. with major depression either do not receive treatment or the treatment they do receive is not adequate, according to a report in the January issue of Archives of General Psychiatry. The report further states that certain ethnic and racial groups are even less likely than other groups to receive adequate care for their depression.

Hector M. Gonzales and his colleagues at Wayne State University in Detroit analyzed data from the National Institutes of Mental Health's Collaborative Psychiatric Epidemiology Surveys, which combined three nationally representative studies. During these studies, face-to-face interviews were conducted with 15,762 adults between 2001 and 2003.

Of those surveyed, 8.3% had major depression, including 8% of Mexican Americans, 11.8% of Puerto Ricans, 7.9% Caribbean blacks, 6.7% African Americans and 8.5% non-Latino whites.

Overall, more than half of those with depression received at least one form of care, but only 21.3% of these received care that conformed with established treatment guidelines.

Mexican Americans and African Americans consistently had lower odds of receiving any type of care or care in alignment with established guidelines. Puerto Ricans and non-Latino whites, however, were twice as likely as Mexican Americans, Caribbean blacks and African Americans to use therapies that were in agreement with treatment guidelines.

According to the authors, these results point out the importance of breaking down larger ethic and racial groups into subcategories. "Failing to do so obscures depression care research, especially for the largest and fastest-growing segment of the U.S. population, Latino individuals, and especially Mexican American individuals."

"With the recent passing of a U.S. Mental Health Parity Act, our findings should provide guidance to better-enabled mental health to improve the depression care of all Americans and for reducing disparities among ethnic/racial minorities," the authors concluded.

More and more U.S. patients are being prescribed multiple psychotropic medications - including antidepressants and antipsychotic medications - according to a report in the January issue of Archives of General Psychiatriy.

According to background information provided in the report, there is some evidence that combining different types of psychotropic medications may be beneficial for patients. For example, if a patient does not respond completely to a particular antidepressant, they may respond better if given a second antidepressant with a different mode of action.

In order to examine trends in this phenomena of prescribing multiple psychotropic medications, Ramin Mojtabai of Bloomberg School of Public Health, Johns Hopkins University and Mark Olafson of Columbia University Medical Center and the New York State Psychiatric Institute, analyzed data collected from a national sample of office-based psychiatric practices. The data included medications and combinations of medications prescribed during a total of 13.079 office visits made by adults between 1996 and 2006.

Overall, there was an increase in the number of psychotropic medications prescribed. Between 1996 to 1997 and 2005 to 2006, the percentage of visits during which two or more medications were prescribed increased from 42.6% to 59.8%. In addition, the percentage of visits during which three or more medications were prescribed rose from 16.0% to 33.2%. The median number of drugs prescribed at each visit increased from one to two.

Combinations of antidepressants with sedative-hypnotics were most common (23.1%), followed by combinations of antidepressants and antipsychotics (12.9%) and combinations of two antidepressants (12.6%).

The authors suggest that this growing trend should be curtailed because there is "scant data to support the efficacy of some of the most common medication combinations." In addition, there is growing evidence regarding the adverse effects of these combinations. For example, certain combinations have been associated with weight gain and increases in cholesterol levels.

"Prudence suggests that renewed clinical efforts should be made to limit the use of these combinations to clearly justifiable circumstances," the authors conclude.

A habit is any action that we have performed so often that it becomes almost an involuntary response. If we consider this habit to be undesirable then we may label it a "bad habit". People spend countless hours and dollars each year attempting to break these bad habits and often do not have any success. Why? Because there is no magic bullet. Change is hard work and there is no short cut to achieving it. The steps a person needs to take, however, can be very simply outlined. To effect a change in habits, one needs to bring the action back into the realm of consciousness and regain the ability to make choices. Read More