The STAR*D Study: A Four-Course Meal That Leaves Us Wanting More
Abstract
This issue of the Journal features an article by Rush and colleagues that provides an overview of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. The STAR*D study is the largest prospective study of a sequential series of treatments for depression ever conducted. In this study, 3,671 patients entered treatment at 41 sites, 18 of which were primary care facilities. The study included a variety of baseline and outcome measures that provide a wealth of information about the characteristics of the patients and their response. The STAR*D study differs from typical clinical trials. Subjects were identified as they came for treatment. Symptomatic volunteers were not included. Inclusion criteria were generous. Although psychotic and bipolar patients were excluded, most other psychiatric disorders were allowed. Most clinical trials in depression exclude patients with recent active substance abuse. STAR*D only excluded patients likely to need inpatient detoxification. Of the patients entering the first treatment step, 61.5% had a concurrent psychiatric disorder. As the result of broad inclusion criteria, the STAR*D study is more representative of patients in clinical practice. The study confirms that about one-third of patients achieve remission with initial treatment and that remission rates decline with successive treatment