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Randomized Controlled Trial
. 2006 Nov;163(11):1905-17.
doi: 10.1176/ajp.2006.163.11.1905.

Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report

A John Rush  1 , Madhukar H Trivedi, Stephen R Wisniewski, Andrew A Nierenberg, Jonathan W Stewart, Diane Warden, George Niederehe, Michael E Thase, Philip W Lavori, Barry D Lebowitz, Patrick J McGrath, Jerrold F Rosenbaum, Harold A Sackeim, David J Kupfer, James Luther, Maurizio Fava
Affiliations
Randomized Controlled Trial

Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report

A John Rush et al. Am J Psychiatry. 2006 Nov.

Abstract

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.

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