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Sequenced Treatment Alternatives to Relieve Depression (STAR*D)

Design: - 23 psychiatric & 18 primary care sites - Level-1: 2876 patients, mean age 41 - Level-2: 727 patients who did not achieve remission with citalopram - Level 2 (second) arm 565 patients Treatment: 1) citalopram for 14 weeks 2) patient who did not achieve remission with citalopram a) bupropion, sertraline or venlaxafine SR for 14 weeks b) bupropion or buspirone added to citalopram Hamilton Rating Scale for Depression used for assessment. Results: 1) 28% of patients with major depression with remission during initial SSRI therapy 2) 1/4 had remission after a different antidepressant was substituted or after a second drug was added 3) switching to a 3rd antidepressant monotherapy after 2 unsuccessful antidepressant trials resulted in low rates of remission (< 20%) [2] 4) remission rates low among patients who have failed pior treatment for depression [3] additional levels are underway in study

Related

major depression

General

clinical trial

References

  1. Trivedi MH et al, Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. Am J Psychiatry 2006; 163:28 PMID: 16390886 - Rush AJ et al Bupropion-SR, sertraline, or venlaxafine-XR after failure of SSRI for depression. N Engl J Med 2006; 354:1231 PMID: 16554525 - Trivedi MH et al, Medication augmentation after the failure of SSRIs for depression. N Engl J Med 2006; 354:1243 PMID: 16554526 Rubinow DR Treatment strategies after SSRI failure -- Good news and bad news N Engl J Med 2006; 354:1305 PMID: 16554533 http://www.edc.gsph.pitt.edu/stard/
  2. Fava M et al, A comparision of mirtazapine and nortriptyline following two consecutive failed medication treatments for depressed patients: A STAR*D report. Am J Psychiatry 2006; 163:1161 PMID: 16816220 - Menza M. STAR*D: The results begin to roll in. Am J Psychiatry 2006; 163:1123 PMID: 16816210
  3. Nierenberg AA et al, A comparison of lithium and T3 augmentation following two failed medication treatments for depression: A STAR*D report. Am J Psychiatry 2006, 163:1519 PMID: 16946176 - McGrath PJ et al, Tranylcypromine versus venlaxafine plus mirtazapine following three failed antidepressant medication trials for depression: A STAR*D report. Am J Psychiatry 2006, 163:1531 PMID: 16946177 - Valenstein M. Keeping our eyes on STAR*D Am J Psychiatry 2006, 163:1484 PMID: 16946168
  4. Cain RA. Navigating the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study: practical outcomes and implications for depression treatment in primary care. Prim Care. 2007 Sep;34(3):505-19, vi. PMID: 17868757
  5. Thase ME, Friedman ES, Biggs MM et al Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report. Am J Psychiatry. 2007 May;164(5):739-52. PMID: 17475733