The 30 percent remission rate is similar to those seen in uncomplicated, non-chronic
volunteers enrolled in SSRI efficacy trials. However, efficacy trials with chronic
patients more like the STAR*D patients typically produce only a 22 percent remission
rate. Again, the researchers attribute this better than expected remission rate
to the systematic and comprehensive approach to care, which enlists the patient
as a collaborator by providing tools for self-monitoring.
Patients who did not achieve remission or did not tolerate citalopram were invited
to participate in phase 2 of STAR*D, in which the drug was either augmented or
replaced by other treatments, including cognitive therapy. People who still did
not improve sufficiently could enroll in to two additional levels. The researchers
followed up successful responders for a year to monitor each treatment?s long-term
outcomes.
?Tools used in research settings (depression rating scales, etc.) are not routinely
used in practice, which may contribute to the high rates of inadequate treatment
with antidepressant medications in routine care,? suggest Trivedi, Rush and colleagues. ?Our
results also suggest that the use of depressive symptom and side effect ratings
to guide treatment is feasible in ?real world? practices as well as effectiveness
trials and can be used to monitor patient progress, to adjust the treatment,
and to make clinical decisions.?
Other study authors include:
- Stephen Wisniewski, Ph.D., University of Pittsburgh
- Andrew Nierenberg, M.D., Massachusetts General Hospital
- Diane Warden, Ph.D., University of Texas Southwestern Medical Center
- Louise Ritz, M.B.A., NIMH
- Grayson Norquist, M.D., University of Mississippi
- Robert Howland, M.D., University of Pittsburgh
- Barry Lebowitz, Ph.D., University of California, San Diego
- Patrick McGrath, M.D., Columbia University
- Kathy Shores-Wilson, Ph.D., University of Texas Southwestern Medical Center
- Melanie Biggs, Ph.D., University of Texas Southwestern Medical Center
- G.K. Balasubramani, Ph.D., University of Pittsburgh
- Maurizio Fava, M.D., Massachusetts General Hospital
Q&As for more information on the Star-D study: