What did we learn from the STAR*D study?

Sequenced Treatment Alternatives to Relieve Depression (STAR*D) was the largest study ever conducted to evaluate the best treatment approaches for outpatients with major depression who had not achieved a satisfactory response after initial treatment. STARD studied approaches to changing antidepressants for nonresponse. The study found that 70 percent of those who did not withdraw from the study eventually became symptom-free, however there were few differences in effectiveness across particular antidepressants. The investigators concluded that in choosing an antidepressant for this population, patient acceptance is more important than the type of antidepressant. Psychotherapies such as cognitive behavioral therapy should be offered before a third medication step is taken given its high tolerability and effectiveness.


Gaynes, B.N., Brown, C., Lux, L.J., et al. Management Strategies To Reduce Psychiatric Readmissions (Technical Briefs, No. 21). (2015 May). Rockville (MD): Agency for Healthcare Research and Quality (US). Available from: https://www.ncbi.nlm.nih.gov/books/NBK294451/

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