Dr. Mayberg explains if anti-depressant medications become less effective over time.
Well, it’s very interesting about anti-depressants. The question is, “Do antidepressants lose their effectiveness over time,” or “Does the illness come back?” And I, for one, am not sure how to make that distinction, and that really gets down to is it like you get, it’s not quite like taking painkillers where you have pain, you take a painkiller, and the dose you are taking needs to keep being increased in order to get the effective pain relief.
For treating depression, once a dose is established and the symptoms are recovering, you tend to take that dose. And the question is, “What does it mean when that particular dose stops working?” For many patients, doctors will try to increase the dose and sometimes that can be effective, but, in fact, it may be that as the illness comes back, in many cases it can be like the illness is stronger.
And so, I mean, this is the point of research, is to understand why don’t the medicines always hold the illness or, set another way, why can the illness break through the treatment? It’s not quite like, you know, taking insulin or taking a blood pressure medicine, and sometimes you eat a little too much sugar or have a little extra piece of cake and you need to increase your insulin to handle the rise in your blood sugar. We don’t understand depression that way.
It is not like you are a quart low on some biochemical and you need to keep topping off the tank. We have every reason to believe it really doesn’t work that way because of what we don’t know about what causes depression. We try to make educated guesses about why we see what we see in our patients, which is someone can be doing very well on a medication and it just seems to poop out. And unfortunately, for many patients, it can have worked well for over a long period of time, and when it does poop out, the next medication is hard to find that can be equally effective, and that’s one of the mysteries of the illness that researchers are trying to understand.
About Dr. Mayberg, M.D., FRCPC:
Helen Mayberg, M.D., FRCPC, if a Professor of Psychiatry Neurology at Emory University School of Medicine. She received her bachelor’s degree in Psychobiology from the University of California and her medical degree from the University of Southern California, School of Medicine. Her research concerns the characterization of neural systems mediating mood and emotions in health and disease using functional neuroimaging. Defining brain mechanisms underlying major depression is the primary goal, with an emphasis on development of algorithms that will discriminate patient subgroups, optimize treatment selection, and provide markers of disease vulnerability.