Multi-step treatment benefits depressed patients

NEW YORK (Reuters Health) - Multi-step treatment for depression can be effective in about two thirds of patients, according to a study published in the American Journal of Psychiatry.

Dr. A. John Rush, of the University of Texas Southwestern Medical Center, Dallas, and colleagues came to this conclusion after studying 3,671 adult outpatients with depression who participated in one to four successive treatment steps.

Patients who did not achieve remission -- a significant improvement in symptoms of depression -- or were unable to tolerate a treatment step, were asked to continue on to the next step. Subjects who experienced an acceptable benefit from any specific step could enter a 12-month follow-up phase.

All 3671 participants entered step one, 1,439 moved on to step two, 390 entered step three, and 123 entered step four. The corresponding percentages of patients who achieved remission were 36.8, 30.6, 13.7, and 13.0 percent. Overall, roughly two thirds of patients achieved remission.

Relapse rates during the follow-up period were higher among patients who required more treatment steps.

"Remission is the thing you really... want to try and achieve," Rush said in a statement. "The more steps it takes to get better or to remission, the more carefully a patient needs to be followed, because the more likely that individual is to have a relapse."

SOURCE: American Journal of Psychiatry, November 2006.