Sequenced Treatment Alternatives to Relieve Depression
The STAR*D study is the largest and longest study to ever look at treatment for moderate-to-severe depression. The results of the STAR*D study came out in 2006. Participants in the study included a diverse group of 2,876 adults in treatment at one of 41 different clinics across the United States.
The study showed that nearly 70% of people suffering from moderate-to-severe depression became "symptom free" with persistent, robust treatment.
Within the first two months of treatment with a well-dosed antidepressant, 33% of people became symptom free.
With adjustments to the treatment over the course of the next 2 months, the number of people who became symptom free increased to a total of 57%.
With a third round of adjusted treatment over the next few months, the number of people
who became symptom free increased to a total of 63%.
Finally, with a fourth round of adjusted treatment, the number of people who became symptom free increased to a total of 67%.
A few take-home messages from the STAR*D study:
Because of this landmark study, you may hear a psychiatrist encourage you to stick with treatment, even when you feel like giving up. This study shows us that - for treatment of depression - persistence often pays off. When it seems as if a medication isn't working for you - it's possible that you haven't been on the medication long enough for it to do its job.
You may also hear a psychiatrist recommend that you try a different medication - even though none of the other medications you've tried has worked. In the midst of the depression, you may feel hopeless. Maybe it seems pointless to try something else. Maybe you wonder if your doctor is just making wild guesses. Maybe you feel "like a guinea pig". The STAR*D study shows us that different treatments may be more helpful than the first antidepressant medicine you tried. If at first you don't succeed,... Try and try and try again. Only 33% of people suffering from depression became symptom free during treatment with the first antidepressant medication that was tried. That number increased to 67% after second, third, and even fourth antidepressant treatments were tried. Trying something else is a strategic approach to the treatment of depression. If you are struggling with persistent depression, it pays to switch to a different depression treatment (either talk therapy or a different medicine) or to "augment" treatment (that is, boost the effectiveness of your current treatment by adding talk therapy or an additional medicine).
Sources:
The STAR*D Project Results: A Comprehensive Review of Findings. Diane Warden PhD et al. Current Psychiatry Reports. 9:449-459. 2007. Click here.
Questions and Answers about the NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study - All Medication Levels. NIMH. November 2006. Click here.
The STAR*D study: Treating depression in the real world. Cleveland Clinic Journal of Medicine. 75(1):57-66. February 2008. Click here.
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study. Notes and a Diagrammatic Summary by David Straton. Click here.