Depression treatment in my Scottsdale office represents about 60% of my practice. In treating depression, especially treatment refractory depression we will at times use Symbyax, a drug which combines Olanzapine and Fluoxetine. Much research has been done with the augmentation of medications to increase the effectiveness of treatment. This combination is often used in treatment refractory depression, treatment resistant OCD, anxiety, and sometimes ADHD. Studies have demonstrated that the sooner both medications are used, the better the prognosis. Postponing depression treatment can have a deleterious effect on your body and cause brain damage in that depression has been found to kill brain cells in the hippocampus region of the brain. Read about depression and brain damage.
A recent study of patients suffering with treatment resistant depression was conducted using Olanzapine (Zyprexa) and Fluoxetine (Prozac), (O/F from here forward). These two medications are combined into one which is known by its trade name Symbyax. The objective of the study was to observe the responses of patients with treatment resistant depression who were being treated from the onset with both O and F. Researchers were looking for the predictive relationships of early improvement during acute episodes of depression and also in times of relapse. Treating depression is a field of great interest since the recurrences of depressive episodes ranges from as high as 10% to 60%. I believe that these relapses that occur after treating major depression are often due in part to not continuing the antidepressant medications for at least 12 months after the symptoms have subsided. This is often is due to the patient’s belief that they have been “cured” of major depression and their stopping treatment. This often occurs in patients with anxiety disorders as well. Whatever the cause of the recurrences, finding a better treatment is the focus of many studies.
Depression Treatment With Both Medications is Important
The study showed the importance of treating depression with both O/F from the onset. This was a predictable finding in that the study showed several important findings. First off the group in the study that was given a combination of O/F from the onset began to see an improvement in their conditions within the first 2 weeks compared to the other groups (to the degree of 25% in some cases) that saw either delayed responses ranging from 3 to 8 weeks before the symptoms noticeably reduced, and other groups given only one of the medications which saw no efficacy at all during the 8 week treatment. The overall treatment using the adjunct therapy of O/F also showed better long term results of treating major depression in the patient groups as well.
Treating major depression with two medications from the start often yields a much quicker effect of diminishing the symptoms
In treating major depression studies like this tell us is that often it is better to begin a treatment plan for major depression with a patient using a combination of O/F from the onset which will be more likely to yield a faster acting effect on the depressive symptoms and also a better overall prognosis. This will give the patient more immediate relief from the symptoms of the depressive disorder, it will provide quicker information to the doctor with regards to having chosen the right course of treatment; and it will give the patient more confidence in medication management. This last benefit is crucial in avoiding a depressive relapse; of which one of the best ways to avoid this is by maintaining the medications for at least 12 sometime 18 months. Even after the symptoms have dissipated; this should be a primary consideration in treating major depression.
One of the challenges to the patients when using an adjunct approach to treating major depression with O/F are the possible side effects of both medications and the cost. I believe that a few factors in determining when to use this approach will be flushed out during the patient evaluation. If a patient has revealed that he or she is experiencing a relapse from a former treatment of major depression, or has been treated for major depression before and the treatment has not produced any noticeable relief from the symptoms; these patients might be good candidates to begin with a O/F treatment approach from the start. Another good scenario for augmentation would be severely depressed patients that come to you for the first time and are extremely debilitated. These patients might benefit from this rapid onset response of both medications. After some degree of stabilization has been achieved, backing off to one or the other medications can be discussed with the patient; however in any case, every patient should be informed at the unset of the treatment of the necessity to remain on the medications for the longer period of time to avoid relapse; in which case the effects of the relapse would be much worse than an extended medication treatment plan. Treating major depression can be very effective in a relatively short time frame if the right approach is taken from the start. Failure to begin treatment in certain cases with augmented medication management could prove to be more costly in the long run. Are you seeking depression treatment in Scottsdale and need an experienced Scottsdale psychiatrist? Please contact me to schedule an appointment.