The STAR*D project results: A comprehensive review of findings
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The Sequenced Treatment Alternatives to Relieve Depression trial enrolled outpatients with nonpsychotic major depressive disorder treated prospectively in a series of randomized controlled trials. These were conducted in representative primary and psychiatric practices. Remission rates for treatment steps 1 to 4 based on the 16-item Quick Inventory of Depressive Symptomatology-Selfreport were 37%, 31%, 14%, and 13%, respectively. There were no differences in remission rates or times to remission among medication switch or among medication augmentation strategies at any treatment level. Participants who required increasing numbers of treatment steps showed greater depressive illness burden and increasingly greater relapse rates in the naturalistic follow-up period (40%–71%). Prognosis was better at all levels for participants who entered follow-up in remission as opposed to those who entered with response without remission. These results highlight the prevalence of treatment-resistant depression and suggest potential benefit for using more vigorous treatments in the earlier steps.
KeywordsRemission Rate Mirtazapine Depressive Symptomatology Cognitive Therapy Treatment Step
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References and Recommended Reading
- 4.Akiskal HS, Akiskal K: Cyclothymic, hyperthymic and depressive temperaments as subaffective variant of mood disorders. In American Psychiatric Press Review of Psychiatry. Edited by Tasman A. Washington, DC: American Psychiatric Press; 1992:43–62.Google Scholar
- 5.Kocsis JH, Klein DN: Diagnosis and Treatment of Chronic Depression. New York: Guilford Press; 1995.Google Scholar
- 11.Depression Guideline Panel: Clinical Practice Guideline, Number 5: Depression in Primary Care: Volume 2. Treatment of Major Depression. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1993.Google Scholar
- 18.Greden JF: Clinical prevention of recurrent depression. The need for paradigm shifts. In Treatment of Recurrent Depression. Edited by Greden JF. Washington, DC: American Psychiatric Press; 2001:143–170.Google Scholar
- 25.Rush AJ, Trivedi MH, Ibrahim HM, et al.: The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 2003, 54:573–583. [Published erratum appears in Biol Psychiatry 2003, 54:585.]PubMedCrossRefGoogle Scholar
- 27.Trivedi MH, Rush AJ, Ibrahim HM, et al.: The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med 2004, 34:73–82.PubMedCrossRefGoogle Scholar
- 29.Trivedi MH, Rush AJ, Gaynes BN, et al.: Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care. Neuropsychopharmacology 2007 [Epub ahead of print].Google Scholar
- 37.Thase ME, Rush AJ: Treatment-resistant depression. In Psychopharmacology: Fourth Generation of Progress. Edited by Bloom FE, Kupfer DJ. New York: Raven Press; 1995:1081–1097.Google Scholar
- 42.Thase ME, Friedman ES, Berman SR, et al.: Is cognitive behavior therapy just a ‘nonspecific’ intervention for depression? A retrospective comparison of consecutive cohorts treated with cognitive behavior therapy or supportive counseling and pill placebo. J Affect Disord 2000, 57:63–71.PubMedCrossRefGoogle Scholar