Less Than a Quarter of Those with Depression Respond to Treatment in Real Life

In a real-world setting, less than a quarter of patients diagnosed with depression improved with medication, hospitalization, and therapy.

70
11100

In a new study conducted in a real-life setting, only 24.2% of patients with depression responded to treatment, including treatment with multiple drugs, hospitalization, and add-on psychotherapy.

The study was conducted by an international group of researchers in Austria, Belgium, Italy, Israel, and the UK and had pharmaceutical industry funding. Lucie Bartova, Gernot Fugger, and Siegfried Kasper led the research at the Medical University of Vienna, Austria.

Their rationale for conducting the study was their belief that “Despite plenty of effective antidepressant (AD) treatments, the outcome of major depressive disorder (MDD) is often unsatisfactory, probably due to improvable exploitation of available therapies.”

As the researchers put it, the problem is not that antidepressants are ineffective but rather that these treatments are simply not used enough. They argued that the “available therapies” need to be “exploited” more.

Their study tested this proposition. In a real-life setting, people with MDD were given these treatments as needed, including multiple medications, hospitalization, and add-on psychotherapy. If these treatments were effective—and simply not being used enough—then this study should show an extremely high success rate since everyone in the study received some or all of these treatments.

Yet their study showed dismal results. Despite aggressive treatment, only 24.2% of the participants were rated as “responding” to treatment—much less recovering from depression.

The researchers rated 34.3% as non-responders and noted that the remaining 41.4% became “treatment-resistant”—which is the stigmatizing psychiatric term for when multiple medications fail to help people.

The analysis included 1279 patients diagnosed with a current depressive episode. All were prescribed an antidepressant drug. In addition, 33.9% were hospitalized, and 31.2% received add-on psychotherapy (mainly CBT). More than half (58.7%) ended up on multiple medications for MDD, including multiple antidepressants, antipsychotics, benzodiazepines, and other combinations of drugs.

So who did the best out of all these options? The researchers write that there was actually no difference. People who were given drugs alone, and people who received the combination of drugs and therapy, had the same likelihood of improvement—again, about 25%.

To put this more clearly: If you are diagnosed with depression, you have a 24.2% chance of getting better (even after aggressive treatment, including multiple drugs and hospitalization). However, you’re about twice as likely (41.4%) to be called “treatment-resistant” at the end of that treatment and see no improvement.

How much of that 24.2% “response” rate is due to the placebo effect? Unfortunately, this study had no placebo group to which we could compare this effect, but in clinical trials, the placebo effect averages about 31%—meaning that more people would be expected to benefit from a placebo than benefited from aggressive drug treatment in this study.

Antidepressants have many harmful effects—such as weight gain, sexual dysfunction, and emotional numbing—and are challenging to discontinue once started. One implication of this study is that even in the best-case scenario, more than 75% of those seeking treatment are exposed to the adverse effects and potential withdrawal effects of antidepressants without seeing a benefit from the drug.

In a previous study on the same group of participants, the researchers found that antidepressant treatment was least likely to be successful in patients with severe depression, suicidality, comorbid anxiety, or previous episodes of depression. That is, antidepressants are least likely to work for the people who are given them most aggressively—those who are suicidal and have severe symptoms.

In the present study, the researchers focused on the fact that add-on psychotherapy did not seem to help rather than on the low response rates across the board. They use the failure of add-on therapy to theorize about a proposed “complex biological” origin for MDD.

They write, “It should be highlighted that the employment of additional [psychotherapy] was not associated with a superior treatment outcome in our population of adult MDD in- and outpatients, which might emphasize the fundamental role of the underlying complex biological interrelationships in MDD and its treatment.”

 

**

Pharmaceutical giant Lundbeck funded the research. The researchers also had numerous financial ties to the industry:

Dr. Bartova has received travel grants and consultant/speaker honoraria from AOP Orphan, Medizin Medien Austria, Vertretungsnetz, Schwabe Austria, Janssen and Angelini. Dr. Dold has received travel grants and consultant/speaker honoraria from Janssen-Cilag. Dr. Zohar has received grant/research support from Lundbeck, Servier, and Pfizer; he has served as a consultant or on the advisory boards for Servier, Pfizer, Solvay, and Actelion; and he has served on speakers’ bureaus for Lundbeck, GlaxoSmithKline, Jazz, and Solvay. Dr. Mendlewicz is a member of the board of the Lundbeck International Neuroscience Foundation and of the advisory board of Servier. Dr. Souery has received grant/research support from GlaxoSmithKline and Lundbeck; and he has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Lundbeck. Dr. Montgomery has served as a consultant or on advisory boards for AstraZeneca, Bionevia, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Grunenthal, Intellect Pharma, Johnson & Johnson, Lilly, Lundbeck, Merck, Merz, M’s Science, Neurim, Otsuka, Pierre Fabre, Pfizer, Pharmaneuroboost, Richter, Roche, Sanofi, Sepracor, Servier, Shire, Synosis, Takeda, Theracos, Targacept, Transcept, UBC, Xytis, and Wyeth. Dr. Fabbri has been supported by Fondazione Umberto Veronesi (https://www.fondazioneveronesi.it). Dr. Serretti has served as a consultant or speaker for Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, and Servier. Within the last three years, Dr. Kasper received grants/research support, consulting fees, and/or honoraria from Angelini, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Mundipharma, Neuraxpharm, Pfizer, Sanofi, Schwabe, Servier, Shire, Sumitomo Dainippon Pharma Co. Ltd., sun Pharma and Takeda. All other authors declare that they have no conflicts of interest.

 

****

Bartova, L., Fugger, G., Dold, M., Swoboda, M. M. M., Zohar, J., Mendlewicz, J., . . . & Kasper, S. (2021). Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disorder – evidence from the European Group for the Study of Resistant Depression. Journal of Psychiatric Research, 141, 167-175. https://doi.org/10.1016/j.jpsychires.2021.06.028 (Link)

70 COMMENTS

  1. Testimony. Victim of criminal psychiatry. Suffering, suffering, suffering.

    Much retaliation for speaking out about my one of a kind story, yes.

    Depressed, yes.

    The only treatment I need is justice.

    But I’ve been asking and not getting justice for ten years. I’m almost 59 years old and my health is negatively affected.

    I am suffering so much.

    I have achalasia. Disorder of the esophagus. I think my story and pain are stuck in my throat.

    I have been seeking treatment for nearly a year without results.

    No care in my area. In line for care three hours away in Detroit. I have lost almost 50 lbs. I am so hungry. I can’t swallow without vomiting. I went to the emergency room last week. I was sent home to puke. I don’t know how I am supposed to live.

    Nothing nothing nothing nothing nothing nothing is worth criminal psychiatry. It would be better to never be.

    I don’t deserve all this suffering.

    • Gina
      Your suffering is so deeply concerning…Perhaps the fact the ” care ” is hours away is a wonderful thing. There is no known treatment for depression. Perhaps you are destined to take the hero’s journey. Which means you are left to you own devices.
      My friend who is suffering as well has been doing cannabis edibles….he visits his dispensary and tells them he is looking for a strain that will relax him. Then he starts with a very small amount , you can always do more next time . This might help your ability to swallow.
      Personally I get in my car and drive. In my care I can scream as loud as I can. That gets rid of a lot of tension in my throat. Lots of tension. When I view the world as it is…not how I want to to be…..I do need to scream.

    • Traditionally I believe, with depression with limited treatment most people would go through a series of very bad patches and then the problem would ‘burn itself out’.

      It’s only in modern times with universal medications, that ‘depression’ has become a long term condition.

      • I prefer to look at it as most people going through a series of learning experiences and coming up with a more effective way to conduct their lives. Psychiatric “diagnosis” and “treatment” interferes with that natural learning process, both biologically and psychologically.

  2. The “treatments” don’t “work” because there’s nothing “wrong” with the “participants” in the first place. So why do people feel bad? Because life can be tough. And why do they not “get better”? Because they’re being “treated” by A BUNCH OF IDIOTS who oughta quit name calling (“diagnosing”) and stuffing people full of PHARMACEUTICAL JUNK. And guess what? If they’d quit doing THAT, people might just “get better” –

    • I have had two psychrists for the majority of my 33 years clinical depression. Neither one are quacks. I would ask about alternative treatments and my doc would tell me what he has read about it. As long as it wouldn’t hurt me, he would not be against me trying it.

  3. This study is kind of a watershed –considering that it was done by so many researchers with links to the pharma industry, they could be expected to massage or spin the data to show a strong benefit from antidepressant drugs, but nope. Even pharma ads have admitted that “two out of three people who take antidepressants don’t see relief of their symptoms,” and now it looks like it’s three out of four.

    • Big Pharma can be evil, but it’s definitely not stupid. And who knows? They just might have been listening to all the chatter – and it made them nervous. Looks to me like BP orchestrated the whole damn thing just to avoid future lawsuits.

    • Hi Miranda,

      I wonder if these admissions are related to the drugs they are marketing now to treat depression. I saw an ad in Real Simple magazine for nasal spray ketamine.
      It asks, “does trying one antidepressant after another feel like you’re going in circles?”. It talks about using the spray “along with an antidepressant taken by mouth.”

      Before this, Abilify wĂ s marketed similarly, as an “anti depressant adjunct”.

      The timing is interesting! (Same way they downplayed TD until they had a drug for it).

  4. Since their is no such thing as Clinical Depression, the results of this study are of no worth. A more interesting study would be to find out what is wrong with these people’s middle fingers, as in cooperating with the mental health system and with mental health journalists, they clearly are not using it when it is needed.

    Joshua

    • “…you’re about twice as likely (41.4%) to be called “treatment-resistant” at the end of that treatment and see no improvement.”

      The term treatment resistant, once that gets added to a patient’s file, is not an innocuous term. In fact it’s the opposite. For me, being called treatment resistant led to ect, a borderline diagnosis, permanent disability, and threats of more ECT. It is a very charged term.

      There’s a book out about eugenics, called “The War Against the Weak”. I think psychiatry plays a role very similar to what eugenicists were doing — with the support of the US government (department of Agriculture) and wealthy capitalists — prior to exporting their ideas to Germany.

      Here is a talk by the author, Edwin Black:

      https://youtu.be/dfPTaBlheGA

      Did the people who were experimented on at Yale ever see justice? No, me neither. They just told me to buy Life Alert.

      • “Treatment resistant” is such a ridiculous term! It implies that EVERYONE should respond to “treatment,” and that anyone who doesn’t is either personally resisting, or their “disorder” (a mental construct!) is resisting! Why not just say, “Our treatment failed” and leave it at that?

        What would you think if you took your car into the garage, the guy worked on it for two weeks and then gave it back and said, “The problem is, you have repair-resistent fuel injectors! I can’t fix them, but if you come back once a week we can treat the symptoms…” You’d get a new mechanic double quick!!!

        “Treatment resistance” is a loaded term meant to blame the client for the doctor/therapist’s failures.

        • Agreed. If anyone happens to be reading this who has not yet been snatched up in the jaws of the system, I would urge them, if any treatment provider starts using the phrase “treatment resistant” to describe them or a loved one, run. It will almost certainly not end well.
          I have a spotty recollection of that period of time. I was under a lot of stress trying to hold down a job I wasn’t cut out for. My psychiatrist had, for 6 years, been bouncing me from one SSRI to another, way back before anyone knew anything of side effects, akathisia, withdrawal syndromes… way before there were black box warnings. He also had me on Klonopin for years (he told me it was safe and not addictive) and then eventually prescribed Adderall. But I think even back then I had an inkling that these doctors were full of it. The problem was the incredible pressure I was getting from supervisors at my place of employment, family members, friends…to “get help”. I lost any trust I had in myself, which is why I allowed the abuses of the next 15 years to happen. The doctor that did the ECT and the one who had been drugging me for so long both told me that the fact that the doctor who had been drugging me for so long didn’t keep any records was not a big deal, and my thinking it was a big deal was a sign of my anger problem. (One box checked for a BPD diagnosis, four more to go).

          I’m still trying to come to terms with everything that happened. I carried so much shame for so long. Now I only have shame about the effect my problems had on another person.

          People can throw around things like “playing the victim” or “take responsibility”, but I was a victim. I know I’m not the only one.

          • See http://www.isss.org and know there is still time to register for the conference! At one point of my life, time would be spent visiting with a professor at UL, who came to Louisville to serve as the Provost for Spalding University. Then his career took him down the street and we would meet over the film, Fractals: The Colors of Infinity where Arthur Clarke leads off a bit. Seems the tele system and computers have something to do with research, too. And at one point, the Prof I knew served as Pres of the ISSS. So, are there systems that need a voice from outside, inside or in between the dark world of “the system(s)” we invoke?

  5. Steve says, “Treatment resistance” is a loaded term meant to blame the client for the doctor/therapist’s failures.”

    When “treatment” is a “success”, the therapy gets the credit, but when it’s not, they blame the client.

    • I have been on psych meds for 36 years and have been in therapy on and off. I also had debilitating panic attacks. I had agoraphobia which is the fear of being anywhere from which you cannot quickly escape and, let me tell you, that covers almost everything. I functioned because I had to but I white knuckled everything and I could tell you some stories that would make your hair curl. Nobody was paying my bills so I had to work. In short, it was a literal hell. Prior to this I could go anywhere and do almost anything. I worked with the best therapists in the DC area. About 7 years ago I worked with someone who did hypnotherapy. I had done this many times before but the way this person did it, I knew I was under. I addressed the panic attacks. I had read an article about 7 years prior that said the only way to get rid of them was to lose your fear of them and I intellectually thoroughly believed it. I just had to get that through to my subconscious mind. Some months after the hypno, I decided I was done with them, as I had been many many times before. I set out driving feeling like crap but talked to myself how I didn’t care, go ahead, you can’t hurt me. I literally felt the panic symptoms melt away and have been panic free about 7 years now and this was nothing short of miraculous because I lived with this crap daily. Even my generalized anxiety went away because it was, for the most part, about the panic attacks. I had terror attacks in my living room. Now if I could only do the same for depression…however NOBODY ever blamed me for not getting better during all those years.

  6. “Less Than a Quarter of Those with Depression Respond to Treatment in Real Life” – so what percent of people recover from “depression” without any treatment at all?

    https://depression.informedchoices.ca/understanding-depression/what-happens-to-depression-without-treatment/

    So a person is twice as likely to recover from depression within 3 months – without treatment – than if treated with an antidepressant, and without any of the common adverse and withdrawal problems.

    Gosh, maybe the doctors should stop handing out and forcing those antidepressants onto innocent others, and learn to leave people alone instead. Oh, but “that’s not profitable.”

    As a society, or world, is there a point at which we admit that “Fierce Pharma” and “Fierce Medicine” have become … way too greedy?

    • I take issue with this article and your comment. “Depression” is an emotion and we all experience it from time to time however it will not adversely affect those peoples lives. When if gets to the point where you can’t function as in can’t get out of bed, persistent feelings of sadness, hopelessness, suicidal ideation and/or plans, no energy for performing daily hygiene like brushing one’s teeth and taking a shower and there really is no reason for it, one has crossed the line to “clinical” depression. It should not be called “depression” because it is nothing like experiencing a bad mood and minimizes the disorder causing people to think one can just get over it.

      • Just to be clear, Maggie, I don’t think anyone here thinks a person should “just get over it.” That’s a trope that is tossed out by the psychiatric industry to try and discredit their critics, pretending critics are saying, “There’s nothing wrong, just quit whining.” But that’s not the critique here. The proble is the CLAIM that “depression” is a DISEASE STATE without providing any evidence that this is the case, and then pretending they can somehow TELL who “has clinical depression” and “needs medication” while in practice recommending drugs for pretty much every single case they run across.

        I have suffered a lot from chronic depression and it took years, decades really, to truly get a handle on it, and it still is a problem sometimes for me. But I don’t hold that I have a “disease” that can be somehow cured by messing with my brain functioning, because there is no evidence that either of those things are true. I also know that some people find antidepressants helpful on a personal level, and I have no concern about that. But I do have a concern about professionals making claims of scientific support for something they have no actual understanding of, particularly when they approach it in a completely biased manner and deny evidence that really IS scientific, such as the fact that most people do NOT get better on antidepressants, as this article shows us.

        • I do agree that AD’s are over proscribed. They do have studies showing there is some kind of chemical disruption in the brain. I believe it is genetic and definitely runs in my family. There are a heck of a lot of people out there using street drugs/alcohol to self medicate and substance abuse and mental illness are different sides of the same coin. My late brother treated his w Percocet and the difference between when he was high and when he wasn’t was very obvious. After saying this and after going through this since I was about 18, self medicating for 10 years until it stopped working, I still don’t know 100% if it’s nature or nurture. What I do know is I have it and it sucks and everybody is an expert regarding it.

          • I challenge you to show me hard evidence that there is “some kind of chemical disruption in the brain” of all or most people who fit the criteria for “MDD.” The idea of the “chemical imbalance” theory was disproven back in the ’80s, before Proac even came to market. Even mainstream psychiatrists are disavowing this theory and claiming that they never supported it. They’ve moved on to the idea of “circuits” and of “genomic analysis” because their original theories on cause have never panned out.

            Of course, nobody knows if it’s nature or nurture, and as in pretty much everything, including hard biological illnesses like cancer, diabetes, and heart disease, it’s no doubt a combination of both. The “diagnosis” is not made by any kind of brain scan or measurement of brain chemicals or EEG or any kind of measurement – it’s just a list of “symptoms,” and most doctors don’t even bother using those. How would it be possible to distinguish “clinical depression” (supposedly caused by biology) from any other kind of depression just using a checklist of symptoms?

            Your case may be particular, you may have some biological vulnerability, but I would bet that no one has shown you what exactly is wrong with your family inheritance. In any case, just because your case may be biological doesn’t lead to the conclusion that any other case is biological. The psychiatric profession makes a common but serious scientific error in assuming that all subjects with similar presentations have the same problem. This is, of course, nonsense scientifically, as something like a rash can be caused by dozens of things, including poison ivy, prickly heat, the measles, or syphilis. I’d sure want my doctor to be able to tell the difference before they started ‘treating’ my rash!

            The other interesting scientific question is: If there is no objective way to tell who “has” “clinical depression” caused by a “chemical problem,” how would anyone be able to determine what “overprescription” would mean? What’s an appropriate level of prescription look like for a disease that has no reliable physical markers whatsoever? That’s one of the biggest problems with the DSM approach – no one can really tell if the doctor is right or wrong, because it’s all a matter of “clinical opinion.”

            Again, I support anyone who finds antidepressants useful, or anything else that helps them. I don’t deny that depression can be a HUGE problem in a person’s life – been there, done that. But that doesn’t make it a medical problem. The burden of proof should be on those claiming it is, and they haven’t met the standard.

            Additionally, the article itself makes it clear that most people do NOT benefit from antidepressants. Why do you think that is, if it’s a biological problem? Or how can you distinguish the bio-depressed from the psycho-spiritually depressed? Or those depressed because their lives are depressing? How can you tell?

  7. Steve says, “They (psychiatrists) should not just compare to placebo, they should compare to doing nothing at all.”

    Then what on earth would most psychiatrists do with themselves? And isn’t doing nothing at all pretty much what most psychiatrists are doing already? (Opps, I forgot – most are busy making themselves rich while ruining lives). And I doubt many would trade scribbling prescriptions for twiddling their thumbs –

    • Maybe you need a better psychiatrist. I used to call mine or my GP occasionally in the middle of the night whilst having a very bad terror (panic) attack. One time he spent about half hour on the phone with me. I was never billed for this time. I’ve also called during non business hours when in a real bad way. I certainly don’t make a habit of it and now that panic attacks are gone I hardly ever call. I’m fortunate that I can afford to get psychiatrics from outside my insurance plan because the ones in network don’t do that. BTW 150 mg Zoloft works very well for me but I refuse to take it because of sexual side effects and weight gain and I know others with same experience. My psyche docs have always worked with me and made suggestions and asked what I wanted to do. We worked together. They did not demand I do anything. I live in DC suburbs so lots of good docs.

      • You are fortunate to have had that experience. In my long experience, it is not typical. Having money does give a person a lot of options that those with limited funds can’t afford. Not to mention those who are held against their wills. There are a lot of different experiences shared here, and I hope we can all respect that fact.

          • We definitely agree on that, and that’s a good start to a deeper conversationn. It’s very important to understand not everyone has your kind of experience. I have thankfully never been held against my will, partly because I’m older and grew up in an era where “mental health professionals” were more interested in relationships and experience and less in proving biological causation, and because I lucked out and got a really good therapist on the first shot. Plus I am a white male with a college education, privileges the majority of those held against their wills don’t have. But in today’s environment, it’s quite possible I would have been “hospitalized,” because I definitely did express feelings of suicidal ideation during my therapy. I’m happy to have dodged that bullet. Others are not so fortunate.

            My distrust/disdain for psychiatry is not based on my personal direct experience as a client, it is actually based on comparing the conclusions of real scientific research to what front-line psychiatrists and “thought leaders” tell us is true. It started with “ADHD.” My son clearly fit the criteria, and I was concerned it would come up when he got to school age, so I did some research on long term outcomes. I was STUNNED to find that there was no long-term research suggesting that ANY long-term outcome, including academics, school completion, college enrollment, delinquency rates, teen pregnancy rates, social skills, or even self-esteem, was improved for “ADHD” kids taking stimulants vs. those who don’t or who take them only short term. I’ve tracked on the research since then, and that continues to be the case. Yet I heard psychiatrists and school personnel saying things like, “Untreated ADHD leads to school failure and higher delinquency rates,” when “treatment” did nothing to improve those outcomes!

            I have since tracked research on antidepressants, anti-anxiety drugs, antipsychotics, and to a lesser extent, “mood stabilizers,” and the exact same pattern emerges. Antidepressants are insisted on as “life-saving” for suicidal people, yet there is no evidence they reduce the suicide rate, and suggestion that they may actually increase it. Antipsychotics are supposed to be essential long term to prevent “relapses,” yet those who take them long-term are MORE likely to be re-hospitalized or otherwise deteriorate than those who use them short term or not at all (see Harrow’s work, referenced in Anatomy of an Epidemic). These are large scale studies of many people, and don’t imply that no one is helped by these interventions. It means that on the average, people are better off not taking any of these drugs for the long term. And people are not told this, and ought to be.

            So the reason I distrust psychiatry as a profession is because they’ve been dishonest. They’ve claimed that all their DSM diagnoses are entirely or primarily biological in origin, despite a lack of research suggesting this is true, and a commonsense critique that claiming the same cause for everyone’s “depression” or “anxiety” flies in the face of reason. They’ve lied about the research that IS done, and have attempted to suppress real data that comes out which contradicts their desired narrative (Harrow, Kirsch, the WHO intercultural studies, etc.) They accuse people like Robert of being antiscientific or cultists just because their findings challenge that narrative. So no, I don’t trust them, and it’s not for emotional reasons, though I consider a person having been personally brutalized an excellent reason to distrust them anyway. But I’m not one of those. I worked IN the system for years, and I saw what really happened as a result of this system. Not saying that all psychiatrists are evil or stupid, nor that people for whom these treatments work should be denied access to them. But I don’t think medical professionals should lie to people about what they “know” in order to get them to agree to a particular approach. Do you think it’s OK for an entire “medical” industry to misrepresent the facts in order to increase their market share? I don’t, and that’s why I have no trust or respect for psychiatry as a profession, regardless of my positive interactions with some psychiatrists and the reported successes of some percentage of patients.

            I hope that makes things clearer on where I’m coming from. If you haven’t read Anatomy of an Epidemic, you really ought to. It is very well researched and non-emotional in presentation, and might help you understand the “rest of the story” for people who have not been as fortunate as you and I have.

    • When I was a teenager and in group therapy I always wondered why people had to include their diagnosis and medications in their introduction. Almost like they’re trying to get you to believe something that doesn’t have any scientific basis. A primary care doctor focused on improving your overall health is a far better mental health professional than any psychiatrist not willing to acknowledge the problems in their own profession.

LEAVE A REPLY