Sequenced Treatment Alternatives to Relieve Depression (STAR*D)
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Introduction
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:
- citalopram for 14 weeks
- patient who did not achieve remission with citalopram
- bupropion, sertraline or venlaxafine SR for 14 weeks
- bupropion or buspirone added to citalopram
Hamilton Rating Scale for Depression used for assessment.
Results:
- 28% of patients with major depression with remission during initial SSRI therapy
- 1/4 had remission after a different antidepressant was substituted or after a second drug was added
- switching to a 3rd antidepressant monotherapy after 2 unsuccessful antidepressant trials resulted in low rates of remission (< 20%)[2]
- remission rates low among patients who have failed pior treatment for depression[3]
additional levels are underway in study
More general terms
Additional terms
References
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/16554525
Trivedi MH et al, Medication augmentation after the failure of SSRIs for depression. N Engl J Med 2006; 354:1243 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16554526 Rubinow DR Treatment strategies after SSRI failure -- Good news and bad news N Engl J Med 2006; 354:1305 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16554533 <Internet> http://www.edc.gsph.pitt.edu/stard/ - ↑ 2.0 2.1 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: https://www.ncbi.nlm.nih.gov/pubmed/16816220
Menza M. STAR*D: The results begin to roll in. Am J Psychiatry 2006; 163:1123 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16816210 - ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/16946177
Valenstein M. Keeping our eyes on STAR*D Am J Psychiatry 2006, 163:1484 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16946168 - ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/17868757
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/17475733