STAR*D, A Landmark Depression Study Releases Results

The results of the "Sequenced Treatment Alternatives to Relieve Depression" (STAR*D) study are being released in the January 2006 edition of the American Journal Of Psychiatry (AJP), a monthly psychiatric journal of the American Psychiatric Association (APA).


The AJP article, Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice, finds that only 30 percent of chronically depressed patients achieve remission during initial treatment with the selective serotonin reuptake inhibitor (SSRI) citalopram.


This real-world outcome study, led by Madhukar H. Trivedi, M.D., investigated 2,876 outpatients with nonpsychotic depression at 23 psychiatric and 18 primary care sites. Nearly 80 percent had chronic or recurrent major depression and comorbid medical and psychiatric conditions. Patients in both settings did not differ in remission or response rates and a substantial number of patients achieved remission or response at or around eight weeks of treatment.


"This study raises the bar for studies of real life outcomes of treatment for depression by focusing on recovery rather than mere improvement of symptoms. The good and bad news is that 30 percent of patients achieve recovery during initial treatment. While we are pleased about the recovery of so many people, the question of how the majority who do not achieve recovery should be treated is of obvious concern," said Robert Freedman, M.D., AJP editor-in-chief. "For now, the data offer new treatment guidelines for clinicians and realistic estimates of the likelihood of successful outcomes for their patients."


Findings also show that patients who were Caucasian, female, employed, or had higher levels of education or income had higher remission rates. While patients with comorbid disorders (especially anxiety or drug abuse) and general medical disorders were associated with lower remission rates.


"This study should prompt both primary care physicians and psychiatrists to monitor their patient's response to treatment with brief assessment instruments. Currently available instruments such as the QIDS or PHQ-9 may be used to correctly identify and modify treatment for the two-thirds of patients who don't achieve remission with initial treatment," said Darrel A. Regier, M.D., M.P.H., director of the APA's Division of Research. "The scope and design of this large National Institute of Mental Health study makes it a welcome addition to evidence-based treatment with significant practical utility for guiding clinical practice."


QIDS is Quick Inventory of Depressive Symptomatology and PHQ-9 is Patient Health Questionnaire (nine questions).


The STAR*D study was designed to assess effectiveness of treatments and ensure the delivery of adequate treatments.


(Am J Psychiatry. 2006; 163: 28-40).


About the American Psychiatric Association


The American Psychiatric Association is a national medical specialty society whose more than 36,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at psych and healthyminds.