OBJECTIVE: This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. METHOD:A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of <or=5 on the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR(16)) (equivalent to <or=7 on the 17-item Hamilton Rating Scale for Depression [HRSD(17)]) defined remission; a QIDS-SR(16) total score of >or=11 (HRSD(17)>or=14) defined relapse. RESULTS: The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps. CONCLUSIONS: When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed.
RCT Entities:
OBJECTIVE: This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. METHOD: A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of <or=5 on the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR(16)) (equivalent to <or=7 on the 17-item Hamilton Rating Scale for Depression [HRSD(17)]) defined remission; a QIDS-SR(16) total score of >or=11 (HRSD(17)>or=14) defined relapse. RESULTS: The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps. CONCLUSIONS: When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed.
Authors: Claudia Ditzen; Ning Tang; Archana M Jastorff; Larysa Teplytska; Alexander Yassouridis; Giuseppina Maccarrone; Manfred Uhr; Thomas Bronisch; Christine A Miller; Florian Holsboer; Christoph W Turck Journal: Neuropsychopharmacology Date: 2011-12-14 Impact factor: 7.853
Authors: Jennifer L Warner-Schmidt; Kimberly E Vanover; Emily Y Chen; John J Marshall; Paul Greengard Journal: Proc Natl Acad Sci U S A Date: 2011-04-25 Impact factor: 11.205
Authors: Kamilla W Miskowiak; Maj Vinberg; Ellen M Christensen; Jens D Bukh; Catherine J Harmer; Hannelore Ehrenreich; Lars V Kessing Journal: Neuropsychopharmacology Date: 2013-12-10 Impact factor: 7.853
Authors: Colm O'Dushlaine; Stephan Ripke; Douglas M Ruderfer; Steven P Hamilton; Maurizio Fava; Dan V Iosifescu; Isaac S Kohane; Susanne E Churchill; Victor M Castro; Caitlin C Clements; Sarah R Blumenthal; Shawn N Murphy; Jordan W Smoller; Roy H Perlis Journal: Biol Psychiatry Date: 2014-01-19 Impact factor: 13.382