Results from a large clinical trial of patients with unipolar depression show that improvements in mood do not necessarily coincide with a decrease in the sense of hopelessness. Professor James E. Aikens, from the Department of Family Medicine, University of Michigan Health System, found that compared to improvements in mood, hopefulness can lag weeks, and sometimes months, behind relief from other depressive symptoms.
Assessments were made on 573 depressed patients from 37 practices. All the patients were prescribed either fluoxetine (Prozac) sertraline (Zoloft) or paroxetine (Paxil). Assessments of depressive symptoms, social and work functioning, positive wellbeing, hopefulness and somatic (physical) complaints were made at 1, 3, 6 and 9 month intervals, after treatment began.
Aikens found that up to 88 per cent of patients reported total mood improvement by the third month of assessment. In fact nearly 70 per cent of patients showed substantial mood improvement after just one month. However, a sense of continuing hopelessness remained long after depressive symptoms lifted.
Aikens main concerns with the findings is that hopelessness can result in undue pessimism. The upshot of this is that patients can stop taking medication altogether. Patient scepticism about the worth of antidepressant medication is actually a stronger predictor of suicide than the severity of depression.
The implications of these findings point to some necessary adjustments in the follow-up of patients who initially visit their doctor with marked pessimism about the future and/or ideas of suicide, says Aiken. Such patients are likely to require several months of follow-up after the major depressive symptoms lift. Aikens further recommends that doctors consider specific cognitive interventions to help combat hopelessness beliefs, as part of the overall treatment process.
What makes this research and its conclusions particularly relevant is the fact that it challenges current thinking which implies that improvements are achieved once depressive symptoms subside. Depression is a complex interaction of several factors, many of which appear to have different time lines that need to be taken into account before any claim to full recovery can be made.
Aikens, J.E., Kroenke, K., Nease, D.E., Klinkman, M.S., Sen, A (2008) Trajectories of Improvement for six Depression-related Outcomes. General Hospital Psychiatry. 30 (1) 26-31.
Published On: February 22, 2008