Treatment Goal: Getting People Better Faster

One of the questions in depression research is how to help people recover faster from depression. This is desirable not only for the obvious reason (we want to minimize suffering), but also because people may get discouraged when they're in treatment but not experienceing relief. They may even decide to discontinue treatment for this reason. Dr Pierre Blier, a leading Canadian psychopharmacologist, has done research on the way antidepressants work for close to 30 years and suggests that this is the key to figuring out which treatments will help people feel better faster.

In a 2004 interview with Medscape CME (http://cme.medscape.com), Dr. Blier discussed his research noting that he is interested in improving the speed and quality of antidepressants "in the long run"(Medscape Psychiatry & Mental Health. 2004;9(1), http://cme.medscape.com/viewarticle/475413). With this goal Dr. Blier and his team began looking at two systems in the brain. "Initially," he explained, "we focused on the serotonin system because we thought it was a major mechanism by which all these antidepressants could work. In recent years, we have concentrated on the norepinephrine system because it is also important in mediating the antidepressant response, and now we are at the point where we are looking at the interactions of the two systems." These two systems are targeted by two types of antidepressants, selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). These medications also reduce symptoms of anxiety and, as Dr. Blier noted in the interview with Medscape CME, "Eighty percent of depressed patients will have significant levels of anxiety -- it is part of the syndrome."

The take-home message about antidepressant research is one of hope. "It has always been our goal in the treatment of depression to get people better faster. I think this is an achievable goal by really trying to clarify how medications work. Once we know exactly how they work, the goal is to achieve the same pharmacologic end point faster through different tools." Dr. Blier is the prinical investigator at the Canadian site of the studies described on this blog (see post, "Study Details" on June 17, 2009), one of which investigates a possible road to the end point of recovery from depression, whether 2 antidepressants together lead to faster recovery from depression than either one alone.