Depressed patients are finding an improved outlook thanks to antidepressant medications. SSRIs do help those who suffer from depression.

Enough Americans suffer from depression to fill Yankee Stadium 330 times over, and while depression rates continue to rise, people with the illness have reason to be hopeful. A new study shows that doctors are treating the disease more than ever before -- thanks in part to the newest category of antidepressant medication.

The study by Randall Stafford, MD, PhD, assistant professor of medicine at the Standard University School of Medicine, appeared in the April 29, 2002 issue of the Primary Care Companion to the Journal of Clinical Psychiatry. "Our study confirms the belief that the diagnosis and treatment of depression have been impacted by the advent of selective serotonin reuptake inhibitors," said Stafford, lead author on the study. "Findings show that the quality of care received by depressed patients has improved since the introduction of this class of medications in 1988."

SSRIs are one of several categories of antidepressants. While medications in each category are effective in treating the disease, SSRIs (including brands such as Prozac, Paxil and Zoloft) have fewer side effects. Stafford noted that patients who take other types face a greater risk of overdose and more side effects.

The safety profile and relatively limited side effects of SSRIs make them attractive to both physicians and patients, Stafford said, and as a result they are the most prescribed category of antidepressant in the country. Stafford's team conducted the study to examine the drugs' popularity among physicians and to more closely examine their impact on treatment of depressive illness.

"Past studies have focused on broader changes in depression treatment, but we wanted to go beyond this and look at the relationship between SSRIs and other medications," he said. "There was a perception that treatment had changed since the advent of SSRIs, and we wanted objective information to go along with this."

To analyze prescribing trends, Stafford turned to diagnosis and treatment data from the National Disease and Therapeutic Index, a survey of office-based physicians. Stafford and his team selected visits by patients with depression-related diagnoses from1989 to early 2001; the sample of visits ranged from 3,901 in 1989 to 6,385 in 2000.

Stafford found that 70 percent of patients diagnosed with depression in 1987 (the year before SSRIs were introduced) were treated with antidepressant medication, while 89 percent were treated with medication in 2001.

The type of antidepressant prescribed also changed dramatically over this time period. In 1987, tricyclics were the predominant drugs prescribed; of the treated patients, 47 percent were given this type. By 2000, only 2 percent received tricyclics.

The study shows that SSRIs were rapidly adopted by physicians. In 1989, after just one year on the market, Prozac was prescribed to 21 percent of patients. Within six years of introduction, SSRIs were the most highly prescribed type for depression. Stafford said this is unusual because physicians often "take their time to fully adopt recommended drugs."

"There is a perception that SSRIs are definitively better -- even though they've never been shown to treat depression more effectively than other antidepressants," he said. "The perceived superiority probably stems from the drugs' fewer side effects, their promotion by manufacturers and greater public acceptance."

The study also shows an increase in depression-related doctor visits, from 14.4 million in 1987 to 24.5 million in 2001. Stafford said this was likely due to many factors, but the advent of SSRIs certainly played a role. "If you don't have medications you feel comfortable prescribing, your motivation for diagnosing someone as depressed is lower," he said. "Physicians feel comfortable with the treatment options so they're more likely to diagnose and treat their patients."

Stafford said past studies have shown depression is underdiagnosed and undertreated in the United States, so the increase in people being treated is encouraging. "SSRIs are helping to improve the quality of care for people suffering from depression," he said.

Source: Stanford University Medical School. May 1, 2002

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