Limitations in efficacy of antidepressant monotherapy.

Treatment for major depressive disorder does not achieve remission in about 50% of patients following 2 treatment trials. Researchers conducted the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study to compare various treatments for efficacy and tolerability. This article will focus on the efficacy of antidepressant monotherapy as determined by the STAR*D trial. Patients in the first treatment step of STAR*D received citalopram monotherapy and, depending on their response, moved either to follow-up or through a series of up to 4 additional treatment steps, each comprising different monotherapies, combinations, or augmentation treatment options. Only 1 of 3 patients remitted with the initial monotherapy. Rates of remission for each consecutive monotherapy were increasingly lower, suggesting that a series of monotherapy options may not be the best treatment strategy for patients who are nonresponsive to an initial monotherapy.