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. 2015 Jan;60(1):9-13.
doi: 10.1177/070674371506000104.

The STAR*D Trial: It Is Time to Reexamine the Clinical Beliefs That Guide the Treatment of Major Depression

H Edmund Pigott  1
Affiliations

The STAR*D Trial: It Is Time to Reexamine the Clinical Beliefs That Guide the Treatment of Major Depression

H Edmund Pigott. Can J Psychiatry. 2015 Jan.
No abstract available

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Figures

Figure 1
Figure 1
Comparison between predicted, theoretical, and actual step-by-step success rates a Calculated from Figure 7 in STAR*D’s Research Protocol predicting how many patients would have a satisfactory response and enter follow-up. b Calculated by STAR*D’s authors in the summary article. c Calculated from the summary article’s Table 3 “Remission at each step” row but using 4041 as the denominator as all patients were started on citalopram in their baseline visit (that is, (1346 + 439 + 53 + 16)/4041 = 45.9% by step 4). d Calculated from the summary article’s Table 5, column 2, rows 3, 6, 9, and 12, by adding the number of remitted patients entering follow-up and dividing by 4041 (that is, (1085 + 383 + 35 + 15)/4041 = 37.6% by step 4). e Calculated from the summary article’s Table 5, column 6, rows 3, 6, 9, and 12. For each step, subtract the per cent relapse rate from 1.0 and then mulitply by the number of remitted patients entering follow-up (for example, step 1: 1.0 – 0.335 = 0.665 × 1085 = 722 remitted patients who did not have a confirmed relapse during follow-up). Repeat for steps 2 to 4. Add the remitted patients without confirmed relpase for steps 1 to 4 and divide by 4041. f Calculated from the summary article Figure 3’s table, column 5, by adding the number of surviving remitted patients without relapse and (or) drop out during months 10 to 12 and dividing by 4041 (that is, (84 + 20 + 2 + 2)/4041 = 2.7% by step 4). QIDS-SR = Quick Inventory of Depressive Symptoms—Self Report; STAR*D = Sequenced Treatment Alternatives to Relieve Depression
Figure 2
Figure 2
Rates of intolerable side effects and drop out by treatment step a From the “Intolerable side effects” row, Table 3, of the summary article. b Calculated from Figure 1 by adding all patients who exited the study in steps 1 to 3 and dividing by the number enrolled in each step.
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References

    1. Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163:28–40. - PubMed
    1. Fava M, Rush AJ, Trivedi MH, et al. Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatr Clin North Am. 2003;26:457–494. - PubMed
    1. Rush AJ, Trivedi MH, Wisniewski SR, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354:1231–1242. - PubMed
    1. Trivedi MH, Fava M, Wisniewski SR, et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354:1243–1252. - PubMed
    1. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163:1905–1917. - PubMed

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