Since 2008, depression treatment in many areas of our country has been driven by a well known study called the STAR-D Trial. The goal of this trial was to simplify prescribing of medication for depression. STAR-D is a step-wise protocol with different classes of medications at each step. It was developed with the best of intentions, hoping to help more patients find relief from depression. While the STAR-D researchers published impressive results for this protocol, several oversights were made to reach those impressive results. Closer examination of the data reveals that only 38% of patients actually got full relief of depression symptoms. So in looking at this trial and several others, antidepressants are about 38 to 50% effective.
Why bother telling you any of this? Because STAR-D is a prime example of the challenges when attempting to use standardized medical protocols to treat unique individuals. While protocols such as STAR-D are created with the best of intent, they tend to ignore the unique needs of individual patients. As I see it, the future of healthcare should be based on customized treatment for each patient, not picking a certain medication from a restrictive list, because that patient has “reached” a step of a protocol.
There are many other options a skilled psychiatric specialist can recommend before switching classes of medications. These include natural supplements, different therapy techniques, lifestyle changes, and more. Today’s psychiatric experts also have access to and the skill to utilize genetic testing that can help them select medication that has a higher chance of being effective from the beginning. Of course, creating individualized treatment plans takes more time than prescribing from a protocol. There is more time spent getting to know the patient, more time counseling the patient, and more time interpreting lab tests. However, if that patient is you or a loved one, isn’t that time worthwhile?
Sometimes another medication is the right choice, but which medication should you try next. This decision is important as the various depression medications work in different ways. A psychiatric expert will take everything into consideration and choose other options for your treatment. At Axis Integrated Mental Health, our providers work to find the medication or combinations of medications that cause the least amount of side effects with the best results. We call this multi-modal approach, The Axis Way.
Our providers will also coach you on lifestyle changes that can help improve your depression. As the evidence is continuing to show us, things like exercise, nutrition, and meditation can mean the difference between feeling better and needing to try a new medication. We also highly encourage all of our patients to work with a therapist, as the data shows us that the combination of therapy and medications together gives us the best outcomes.
As we all work towards better healthcare delivery, at a lower cost, for more suffering patients, I stand by my conviction. While standardized protocols and technological advances may make treatment faster, is that what patients deserve? A faster prescription for a medication that has a 38% chance of making you feel better seems to place focus on the wrong
I think patients deserve a better chance at being prescribed a well thought out treatment plan that takes into account their unique needs.
As I’ve written before, the push to automate and standardize medicine may come from the right place, but is not in the best interest of patients. When patients are experiencing a disease as unique as depression, we should be spending the time to create a treatment individualized to that patient. That’s how we will be able help patients feel better more quickly. Helping them achieve more time when their lives are in balance. Not more time working through a protocol.