Depression often sneaks up on you like a thief in the night, one minute you are there and the next; you are somewhere else. All too often, that somewhere is not where you need or want to be; want to change that? Then read on . . .
Maybe damned if you don't and damned if you but!
Many clients I see with depression are not happy about taking or being on medication, despite that, it appears to be the first option considered by Doctors! Some have been on medication for years, yet there doesn’t appear to be too many studies on the efficacy of long-term use of antidepressants, but I feel there should be.
This study took me a little by surprise because the combination of antidepressants and SSRI’ of SNRI’ seems to be quite a common combination. Another, somewhat, proven combination treatment for depression is medication and talk therapy. This approach has seen some clinical research as a basis for the recommendation, yet, experientially it seems an unpopular method here in Singapore.
Hypnotherapy stands out as one of the most effective strategic life management methods there is, especially in its ability to promote good states of mental wellness. The behaviours that make life challenging are often a result of too much stress, too little sleep and too little by way of clarity! So, to take back control of your mind and your life, it makes perfect sense to use a methodology that addresses the subconscious mind's role in perpetuating negative, vague and ambiguous states of mind. Hypnosis helps us to create calm relaxing states of mind that make life work better! If you would like to address any concerns you have in this direction, or, if you just want to make your life feel better, then why not make an appointment for a Free Consultation? Hypnosis gives you the ability to have a good life!
The objective here is to help people understand how and why we become illogically trapped into irrational emotional experiences that may actually be happening for reasons different to that which we would imagine! If you want to know more about how Hypnotherapy can help you; why not make an appointment for a Free Consultation?
The rationale for the approach
Psychiatrists and GPs increasingly combine mirtazapine with an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin-noradrenaline reuptake inhibitor) antidepressant for patients whose depression does not respond to a single antidepressant. A large clinical trial led by researchers at the Universities of Bristol, Exeter, Keele, Manchester and Hull York Medical School, and published in the British Medical Journal today, looked at the effectiveness of adding mirtazapine to an SSRI or SNRI in patients who remain depressed after at least six weeks of conventional (SSRI or SNRI) antidepressant treatment. They found that this combination was no more effective in improving depression than placebo and call on doctors to rethink its use.
The study, funded by the National Institute for Health Research, also found that patients taking mirtazapine in combination with another antidepressant had more adverse effects and were more likely to stop treatment than those who took an antidepressant and placebo.
Depression is one of the top five contributors to the global burden of disease and by 2030 is predicted to be the leading cause of disability in high-income countries. People with depression are usually managed in primary care in the UK and antidepressants are often the first line of treatment. However, many patients do not respond to antidepressants.
The National Institute for Health and Care Excellence (NICE) advises GPs to reconsider treatment if there has been no response after 4-6 weeks of treatment. The practice of adding mirtazapine has grown as psychiatrists and GPs search for effective ways of treating those who don't respond to a single antidepressant. Previous small-scale studies had shown that this combination might be effective.
Dr David Kessler from the Centres for Academic Mental Health and Academic Primary Care at the University of Bristol, and lead author of the study said:
"Half of the patients in primary care who take antidepressants remain depressed despite sticking to their treatment, yet there is little evidence about how to treat those for whom the drugs don't work.
"Our study has found that there is unlikely to be a clinically important benefit for mirtazapine over placebo in addition to an SSRI or SNRI antidepressant in primary care patients with treatment-resistant depression and that the combination is not well tolerated. We recommend that GPs think very carefully before adding mirtazapine as the second antidepressant in this group of patients. This is particularly important when there are clear alternatives such as cognitive behavioural therapy, which has been shown to be effective in this group of patients."
About the study
Patients were aged over 17 years, were being treated for depression in primary care, and had been taking an SSRI or SNRI antidepressant for at least six weeks. They were still depressed using the International Classification of Diseases (ICD-10) criteria. All 480 patients who took part continued to take their SSRI or SNRI and were randomly assigned to one of two groups: either additionally taking mirtazapine or a placebo. Neither the patients nor researchers knew to which group each patient had been assigned. They were followed up at 12, 24 and 52 weeks to see whether their depression had improved.
At 12 weeks just under 40% of patients had responded to treatment as measured by a halving of the severity of their depressive symptoms; there was a small difference in favour of the mirtazapine group but it was not clinically important and the study could not rule out the possibility of 'no effect'. Outcomes at the later time points showed even smaller differences between the groups with no evidence of worthwhile benefit over the longer term.
- David S Kessler, Stephanie J MacNeill, Deborah Tallon, Glyn Lewis, Tim J Peters, William Hollingworth, Jeff Round, Alison Burns, Carolyn A Chew-Graham, Ian M Anderson, Tom Shepherd, John Campbell, Chris M Dickens, Mary Carter, Caroline Jenkinson, Una Macleod, Helen Gibson, Simon Davies, Nicola J Wiles. Mirtazapine added to SSRIs or SNRIs for treatment-resistant depression in primary care: phase III randomised placebo-controlled trial (MIR). BMJ, 2018; k4218 DOI: 10.1136/bmj.k4218
Cite This Page:
The University of Bristol. "Drug combination for treatment-resistant depression no more effective than single." ScienceDaily. ScienceDaily, 1 November 2018. <www.sciencedaily.com/releases/2018/11/181101133833.htm>.