Despite having different treatments available for resistant depression, the complexity of the disease makes it difficult for many patients to recover. Previous studies have shown that up to two-thirds of patients fail to achieve remission after a first drug treatment, and that one-third still do not after a second. Now, the DEPRE’5 clinical trial, in which the Bellvitge Hospital and IDIBELL have participated, shows that in patients with resistant depression, changing antidepressants or combining it with psychotherapy can be more effective than increasing the dose when a first treatment with a selective serotonin collection inhibitor (SSRI) does not achieve an adequate response.
The trial, which has been published in The British Journal of Psychiatry, has analysed alternatives when these drugs are not effective with a group of 257 people diagnosed with major depression and insufficient response to an SSRI. The team, led by the group leaders of the CIBER area of Mental Health (CIBERSAM), Víctor Pérez Sola, head of the Psychiatry Service of the Hospital del Mar, and José Luis Ayuso, from the Autonomous University of Madrid, compared five therapeutic strategies: optimization of the dose of the SSRI (control group); switching to venlafaxine (another antidepressant); the combination with lithium (mood stabilizer) or with nortriptyline (tricyclic antidepressant), or addition of psychotherapy focused on problem solving.
Although no statistically significant differences were found between all groups, the approaches with the most consistent results were switching to venlafaxine and combining it with psychotherapy, which also had fewer side effects.
According to Dr. Mikel Urretavizcaya, head of the Psychiatry Service at Bellvitge Hospital and principal investigator of the Psychiatry and Mental Health group at IDIBELL, “the results of the trial may contribute to avoiding the effects of therapeutic inertia, highlighting that it is often better to move on to a second treatment than to wait“.
Along the same lines, Dr. Victor Pérez believes that a personalized approach, which combines medication and psychotherapy, can make a big difference in the management of depression.
The work has been designed as a multicentre trial with blinded evaluation, following international clinical research standards. It has been developed in ten hospitals of the National Health System (SNS), including the Bellvitge Hospital, with funding from the Carlos III Health Institute.
The Bellvitge Biomedical Research Institute (IDIBELL) is a research centre created in 2004 specialising in cancer, neuroscience, translational medicine and regenerative medicine. It has a team of more than 1,500 professionals who, from the 73 research groups, generate more than 1,400 scientific articles per year. IDIBELL is owned by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.
IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centres accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Centre of the AECC Scientific Foundation (FCAECC).