Key takeaways from a recent study on antidepressants

Posted July 13th, 2018 by

The World Health Organization reports 300 million people live with depression, but less than half receive effective treatment.

A recent study in the journal The Lancet has been making headlines for comparing the effectiveness of antidepressant medications — information that is often lacking for patients trying to make informed choices about their treatments. They found that all of the medications were modestly more effective than a placebo and some were more effective than others. With help from our research team, we took a closer look at what these findings really mean and how they compare to what members are reporting on PatientsLikeMe.

Let’s break down the research

Researchers looked at 474 placebo-controlled and head-to-head trials including a total of 100,000+ patients on their first line of treatment for major depressive disorder. They compared the effectiveness of 21 different antidepressants to each other and a placebo. The medications were randomly assigned.

Key takeaways
  • Some antidepressants, such as escitalopram (Lexapro), mirtazapine (Remeron), paroxetine (Paxil), agomelatine (Melitor), and sertraline (Zoloft) were more effective with lower dropout rates (patients who stopped taking the medication due to side effects or other factors).
  • Medications like Reboxetine (Edronax), trazodone (Desyrel), and fluvoxamine (Fevarin) had lower efficacy.
  • The antidepressants with the highest efficacy were amitriptyline (Elavil) and escitalopram (Lexapro), while fluoxetine (Prozac) had the lowest.
  • All of the antidepressants were more effective than a placebo in treating MDD, although the effects were modest.
Some limitations
  • The majority of the clinical trials included in this study were selective and didn’t include people with more complex situations (like living with another condition in addition to MDD).
  • The study didn’t include people with treatment-resistant depression (which could be as many as 30% of people with MDD who have tried two or more medications).
  • Researchers only analyzed short-term treatment (8 weeks), so it’s unclear how the antidepressants may work in the long-term.
  • The study only looked at treatment effectiveness, not tolerability (when the medication works but a person stops taking it because of the side effects).
  • The findings were general and based on average results (across all people in the trials), so there’s little insight on targeting treatments for individuals.
On PatientsLikeMe

Here are some commonly reported ways PatientsLikeMe members are treating their major depressive disorder (MDD):

Bupropion (Wellbutrin)

  • 2,000+ members report taking bupropion (Wellbutrin)
  • 63% say that it’s at least moderately effective in treating their MDD

Duloxetine (Cymbalta)

  • 1,800+ members report taking duloxetine (Cymbalta)
  • 67% say that it’s at least moderately effective in treating their MDD

Venlafaxine (Effexor XR)

  • 1,700+ members report taking venlafaxine (Effexor XR)
  • 74% say that it’s at least moderately effective in treating their MDD

Sertraline (Zoloft)

  • 1,500+ members report taking sertraline (Zoloft)
  • 55% say that it’s at least moderately effective in treating their MDD

Fluoxetine (Prozac)

  • 1,500+ members report taking fluoxetine (Prozac)
  • 61% say that it’s at least moderately effective in treating their MDD
Finding what works for you

Many patients have tried several antidepressants in their search to find what works for them (if you’re a PatientsLikeMe member, you can check out what others have shared about this in a recent study). Some studies also show that medication may be more effective when combined with cognitive behavioral therapy. Talk to your doctor to find the best approach to treatment for you.

Are you on an antidepressant? Join PatientsLikeMe today to share your experience and learn from the community.

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Parkinson’s disease and hyperhidrosis: Sweat struggles + solutions

Posted July 11th, 2018 by

PatientsLikeMe members with Parkinson’s disease (PD) have talked a lot about excessive sweating (aka hyperhidrosis) and heat intolerance with Parkinson’s disease. It can be a “stinker,” as one blogger who has PD recently shared in Parkinson’s News Today.

Can you relate? Read on for more information and some possible adjustments or life hacks that others have tried.

One study found that over 60% of patients with PD experience sweating disturbances like hyperhidrosis (over-secretion of sweat) or hypohydrosis (under-secretion of sweat, which is less common).

The Parkinson’s Foundation and Parkinson’s Victoria cover these issues in their guides to skin, scalp and sweat changes related to PD. In addition to hyperhidrosis, many people with PD experience an extra-oily scalp (or other parts of the body), drenching night sweats and general difficulty with temperature control.

Some of these problems may stem from PD itself, which affects some of the body’s automatic functions, such as blood pressure and temperature regulation.

Research has shown that hyperhidrosis also seems to occur along with “off” times in levodopa treatment and with dyskinesia (jerky movements without tremors).

Possible solutions and hacks

Maria De Leon, M.D., a neurologist with young onset PD, writes on her blog that she understands firsthand the impact that sweating (and related body odor) issues can have on people’s lives. A few things you can try? Dr. De Leon suggests:

  • Talking with your doctor about possible levodopa treatment adjustments and even other treatments that may help, such as propranolol (see what PatientsLikeMe members with PD report about propranolol)
  • Taking lukewarm showers or baths
  • Wearing lightweight cotton clothes
  • Drinking extra fluids, especially water
  • Using antibacterial soap to help prevent body odor, and thorough towel drying before getting dressed
  • Trying clinical or “industrial” strength antiperspirant/deodorants. Dr. De Leon says these “work best if you apply at night before bed time not after showering or will wash off; it takes 6 to 8 hours for antiperspirants to enter sweat ducts and properly clog pores plus the body is cooler at night. But do reapply at least once during the day.”

Elsewhere online, people with hyperhidrosis recommend wearing solid dark colors or clothes with prints to help camouflage sweat marks, using underarm sweat pads, wearing leather shoes to help stave off odor, and bringing a small towel and a spare shirt just in case. A New York Magazine writer with hyperhidrosis (but not PD) rounded up his favorite products for over-perspiration.

Talk with your doctor about any skin- or sweat-related issues you’re experiencing. Dr. De Leon says that anxiety, thyroid problems or other health conditions can also cause or add to excessive sweating.

Join PatientsLikeMe to see what the community says about excessive sweating and heat intolerance with PD, or add a comment below based on your own experiences.

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