Depression: The Benefits of Early and Appropriate Treatment

Depression can have a major influence on health of the patient as well as family and individual quality of life, the activities of daily life, and functioning, in addition to on health care providers such as payers, employers, and payers. Patients with depression typically suffer from multiple comorbidities which compound the negative effects and raise the cost. The economic burden of this illness is substantial as direct medical expenses are being estimated at $3.5 million for every 1000 members suffering from depression. Depression is often under-diagnosed and untreated, especially in primary care, where the majority of patients suffering from depression seek help. Effective strategies for achieving Remission have been discovered and proven to be successful in clinical studies. A prompt diagnosis, early intervention and the right treatment can help ensure remission, stop the relapse of disease, and ease the financial and emotional burden of the illness.

Burden of Depression

Treatment for depression usually is comprised of an antidepressant prescription psychotherapy or both. However, mental health professionals recommend earlier and more intense treatment to increase the chance of achieving Remission, and consequently the reduction of overall costs of treatment. The accepted guidelines for clinical practice stipulate that depression sufferers must go through three phases of antidepressant treatment (ie acute, continuing and maintenance) and finally, remission. which is characterized by

depression through therapy or medication, ultimately leading to remission or the absence of any residual symptoms. The initial treatment phase typically is six to twelve months. 20 It is crucial to remember the possibility that symptoms may improve over the time but they do not get back to normal levels of functioning the treatment program is to be adjusted towards more aggressive treatment (ie the maximum dose of the primary drug) in order to attain the goal of remission. 19 Patients who have residual symptoms after the end in the acute stage suffer an average relapse rate of 76% in comparison to the relapse rate of 25% for those who achieve Remission. 21

When remission has been attained and both physical and emotional functioning has been restored, the second stage of treatment is initiated. This is the point at which the process of treatment the primary goal is to prevent relapses which is defined as a return of the patient’s health to a lower than an optimal psychological and physical state or, in simpler terms an increase in depression symptoms. Relapse can occur prior to when the patient is in remission; however the continuation phase will not start until remission is reached. 20 The minimal recommended duration of treatment during the phase of continuation is between 4 and nine weeks. 20

The maintenance stage of treatment is the an ongoing management of the depressive disorder. In this stage the treatment continues with the aim of preventing the recurrence of an depression incident. 19 Recurrence similar to relapse is defined as a regression of the patient’s condition , or the recurrence of symptoms associated with depression. Recurrence is considered to have occurred once the patient has recovered. The maintenance phase of treatment can be continued for a long time, based on the risk of recurrence. For the first time a depression episode occurs generally, it is recommended to keep going for a period of 12 months.

In light of the progressive and long-lasting nature of depression and its progression, getting Remission is vital to predict the future outcome of terms of severity illness or the onset of new episodes of depression. Recent research indicates a greater than 50% likelihood that a person who has suffered from depression for a single episode will have a second depressive episode within five years. After the second episode of depression the probability of recurrence is increased to around 70 percent. The chance of recurrence is more than 90% when an individual has had a third depression episode. 22-24 Unfortunately the reality is that less than one-third of people suffering from depression receive the appropriate treatment from a professional, and a large portion are not adequately treated to ensure Remission. 25 Patients who don’t get remission are at a greater chance of relapse and the recurrence of depression, longer-term depression episodes, and shorter time between episodes of depression.

The presence of persistent symptoms following treatment is a sign of poor outcomes. The results of the Collaborative Depression Study of the National Institutes for Mental Health revealed that those who had remaining symptoms following recovery were significantly more severe and longer-term course of illness than those who did not have any remaining manifestations. 26 Likewise those who had residual symptoms had relapses three times more quickly and were more likely to experience recurrences and had fewer weeks of symptom-free the follow-up period than patients who were not symptomatic. 26

Individuals who fail to achieve remission also tend to use more healthcare resources as suggested by a report that employees with a history of treatment- resistant depression (TRD) used more than twice as many medical services as those without TRD.27 In the TRD patients, the average annual medical cost was $14 490 per employee versus $6665 for employees who were depressed, but not considered treatment-resistant.27 Similar results were found by a second study that demonstrated that patients with persistent depression had nearly twice the annual healthcare costs of those who had achieved remission.28

The choice in Antidepressant TherapyThe selection of an antidepressant must be based on the medical-historical specifics of each patient. The safety of drugs, the adverse effect profile, tolerability as well as the possibility of interactions between drugs should be considered as they can impact the patient’s adherence to treatment. Different classes of drugs are used in the treatment of depression. The first-line drugs typically used to treat depression are the selective serotonin receptor inhibitors (SSRIs) which are known to are effective and have generally low rates of adverse effects. There are numerous medications in this class, which are that are generic. While they are effective, the older ones like monoamine oxide inhibitors (MAOIs) and tricyclic antidepressants (TCAs) have been linked to heart, anticholinergic and hypotensive consequences, as well as the risk of toxicity that is severe. This is why these medications are often used more as adjunctive or secondary treatments. Many different combinations as well as augmentation techniques are used to enhance the outcomes.

Despite the fact that there are multiple classes of pharmacotherapiesavailable, many sufferers experience a lack of response to treatment with antidepressants at first. One study revealed that two-thirds of patients receiving paroxetine, fluoxetine, or sertraline did not respond (ie did not show an improvement in symptoms clinically significant) to the initial SSRI treatment ( Figure 2). 29 Patients who did not have a sufficient response after the initial treatment often go through a variety of other antidepressants but did not achieve the aim of the remission. The inability to respond is often from inadequate dosing with a limited duration or the inability to tolerate drugs. The positive dose-response relation that is observed in antidepressant therapy suggests that doses should be increased to the most tolerable levels in order to attain the goal of remission and avoid any relapse. If a patient fails to show adequate responses to an antidepressant following four to six weeks of treatment at the initial dose , or within 2 or 4 weeks at the highest dose the treatment should be adjusted through the substitution of another antidepressantor by adding an antidepressant in the current treatment or supplementing the therapy with a different agent. For more details Holistic Rehab Center

DescriptionDepression is a chronic and progressive illness that if not adequately treated, can result in serious morbidity and mortality , as well as increased expenses for employers, payers as well as patients. Despite the immense impact of depression most patients are not treated adequate enough to attain complete remission. Although remission is the main purpose of treatment, it’s often the most difficult goal to attain. Effective strategies for achieving the goal of remission are an increase in dosage or amplification of medications, the combination of psychotherapy and antidepressant treatments, or utilizing medications with multiple mechanisms of action. These strategies are most quickly implemented by means of a treatment plan. Patients who don’t attain remission, which includes those who are taking ineffective treatments are more prone for relapses and recurrences and more depressive episodes that last longer and shorter time between episodes of depression. SSRIs are commonly used as primary treatments for depression due to their efficacy as well as their tolerability and general effectiveness, however, when treatment fails, a different type of antidepressant like one that is an SNRI is recommended. Clinical trials provide evidence that shows that reaching and maintaining a completely cleared state is a feasible goal for those suffering from depression.

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