July 23, 2001 — For people with severe depression, it’s not always easy finding the right antidepressant. They try one prescription after another, as their doctor searches for what works best.
Two recent studies in the Journal of Clinical Psychiatry take a look at drugs that could now add to a patient’s options. One study finds that a drug called Remeron seems to be a good alternative for people who don’t respond to an antidepressant like Prozac, which belongs to a class of drugs called selective serotonin reuptake inhibitors, or SSRIs.
The second study shows that taking a drug called Buspar, which is marketed as an anxiety-reducing drug, along with an SSRI, seems to speed up the effects of the SSRI — but only for a brief time.
When SSRIs became available a few years ago they were heralded as an important step for depression treatment. While they did offer a solution for the majority of patients, they still weren’t the answer for everyone, though, says David L. Dunner, MD, co-author of the Remeron study, and director of the Center for Anxiety and Depression and professor of psychiatry and behavioral sciences at the University of Washington Medical Center in Seattle.
When patients don’t respond to an SSRI — like Prozac, Paxil, or Zoloft — doctors do have a few options. “We can try increasing the SSRI dose, add another psychiatric drug, or switch them to an entirely different drug,” he tells WebMD.
But switching drugs often has its downside, something called “discontinuation syndrome.” It’s a real concern, Dunner says. “Symptoms can include anxiety, numbness and tingling, weird dreams, agitation, depression, flu-like symptoms.” The symptoms are not dangerous, and do eventually go away on their own, but they are uncomfortable nonetheless.
That’s where Remeron comes in. It has been used extensively in Europe but was released only recently in the U.S., Dunner tells WebMD. “[Remeron] is one of a new generation of psychiatric drugs that work by different mechanisms and have different side effects than SSRIs,” he says.
“We showed it was safe and it worked,” he tells WebMD. “It’s another important option for patients.”
Dunner and his colleagues found that Remeron was significantly effective in reducing depression, after patients had failed to respond to an SSRI, and that nearly half of all patients had “considerable improvement in depression,” says Dunner.
Another benefit: Patients who switched drugs abruptly did not experience side effects from suddenly discontinuing their SSRI. And patients also reported fewer problems with sexual function, often a side effect of SSRIs.
The second study — of patients taking an SSRI in combination with Buspar — found that it might also be a useful treatment option for patients with severe depression, writes Björn G. Appelberg, MD, a researcher in the department of psychiatry at the University of Helsinki, Finland.
Appelberg found that during six weeks of treatment, patients taking either the SSRIs Prozac or Celexa, along with Buspar, had significantly greater reduction of depressive symptoms compared to those taking the SSRI with a placebo. There’s a catch, though: the benefit was only seen in the first week. By the end of the study, both groups were doing about the same.
“Not an impressive finding,” says Dunner, regarding the Buspar study. “It looks like it’s a safe [drug] combination, but I don’t know that it’s an effective combination — they only found a difference in the first week, then it disappeared.”
The reason for the short-term improvement could lie in the sedating effects that Buspar has, Dunner says. “So if patients are anxious and sleepless, you may see changes in depressive symptoms — that’s why they saw an effect in the first week. But the lack of sustained effect is troubling.”
As for the Remeron study, it shows that the drug “is not necessarily better but is one option,” says Lauren Marangell, associate professor of psychiatry and behavioral sciences and director of the Mood Disorders Center at Baylor College of Medicine in Houston.
Also, “it helps prove that switching does work, and that there are other options so [patients] shouldn’t lose hope,” Marangell tells WebMD.
But it’s important not to switch drugs too early, Marangell says. “You don’t want to switch after a week or two, because that doesn’t give the first drug enough chance to work. How long to do the first drug isn’t clear, but generally it’s from four to eight weeks. And if you get a partial response, try it even longer. But if you get no response, then switch to a different type of drug — [a non-SSRI] like [Remeron].”