STAR*D

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Alternative Alternative Treatment for Relieving Depression ( STAR * D ) is a collaborative study on depression treatment, funded by the National Institute of Mental Health. The main focus is on the treatment of depression in patients where the first prescribed antidepressants prove to be inadequate. A key feature of this study is its goal to be more generalizable to real clinical situations; this is done through the use of minimal exclusion criteria, incorporating patient preferences, and not blinding treatment (ie patients and doctors both know what treatment the patient receives). STAR * D trials include remission (virtually no symptoms, not just symptom reduction) as outcome measures, as there is evidence that patients with depression who achieve remission function are better and less susceptible to relapse than those who achieve only partial improvement in symptoms

Video STAR*D

Trial

The STAR * D trial enrolled 4,041 outpatients with nonpsychotic depression in 23 psychiatry and 18 primary care sites. The trial was completed in 2006, and data from it has been available since 2008.

These trials involve four different treatment levels, and patients are encouraged to enter the next level of treatment if they fail to achieve remission or response (50% decrease in symptoms) after several weeks.

At level one, patients received selective serotonin reuptake inhibitors (SSRIs) citalopram for up to 14 weeks, with dose adjustments administered by their own physicians. If the patient achieved remission or response during that time period, they could include 12 months of naturalistic follow-up, during which time the researchers had no effect on the treatment plan. Non-sender is encouraged to enter level two.

At the second level, there are seven different treatment options, and cognitive behavioral therapy (CBT) is included as a psychotherapy option. There are three combination options (either antidepressants or CBT added to citalopram), and four switch options (for different antidepressants or CBTs). Those sent or responded were offered 12 months of naturalistic follow-up; non-sender after two drug trials are encouraged to enter level 3; other non-senders entering level 2A, which involves a second antidepressant test.

At level three, patients are offered the addition of lithium or triiodothyronine (thyroid hormone) to their antidepressants, or switch to other antidepressants (mirtazapine or nortriptyline). This continued for 12 weeks.

Level four consists of monaminine oxidase inhibitor tranylcypromine or a combination of venlafaxine and mirtazapine.

Maps STAR*D

Results

For level one, remission rate is 28-33% (depending on the scale of symptoms used), and the response rate is 47%. A higher remission rate is seen in patients who are Caucasian, female, employed, or have higher levels of income or education. Lower remission rates are seen in those with longer depressive episodes, co-occurring anxiety or substance use disorders, and more physical illness.

For level two, patients receiving CBT, either alone or in combination with citalopram, had similar responses and remission rates compared with those who received only the drug; However, for patients who remain in citalopram, those who have other antidepressants added achieve remission faster than those who have CBT added. Among patients switching to different antidepressants, there was no significant difference between different antidepressants.

For level three, remission rates based on the scale of the HAM-D symptom were 12.3% for mirtazapine and 19.8% for nortriptyline, although the difference was not large enough for statistical significance. The remission rate based on HAM-D in combination strategy was 15.9% for lithium and 24.7% for triiodothyronine, but the difference was not statistically significant. However, more patients who received lithium from triiodothyronine left the study because of side effects.

For level four, the mean remission rate was 13%, without statistically significant differences between tranylcypromine and combination venlafaxine/mirtazapine. More patients who received tranylcypromine left the study because of side effects.

Overall, the study findings indicate that patients who did not achieve remission or response after several weeks of citalopram treatment could achieve such results at the end of 14 weeks. The STAR * D researchers stated that their data "suggests that a patient with persistent depression can recover after attempting several treatment strategies, but the likelihood of beating depression is reduced because additional treatment strategies are needed." With treatment failing at a higher pace, the likelihood of smaller remissions - and this decrease is very significant after level two. For those who achieve full remission, there is a decreased likelihood of relapse at 12 months (naturalistic) follow-up compared to patients who only respond.

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See also

• Citalopram
• Venlafaxine
• Mirtazapine
• Antidepressant pharmacology
• Lithium (medicine)
• California rocket fuel
• National Mental Health Institute

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References

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External links

• STAR STAR * D project website, hosted on the website for the Graduate School of Public Health, University of Pittsburgh.
• Alternative Treatment for Relieving Depression (STAR) D, Study, NIMH website.
• Clinical Testing Info - Alternative Sequential Treatment to Relieve Depression (STAR ​​â € <â €

Source of the article : Wikipedia