STAR*D real-world study using citalopram suggests only about one third of chronically depressed patients achieves remission during initial treatment

The major American study, STAR*D (Sequenced Treatment Alternatives to Relieve Depression), showed that only about one third of chronically depressed patients achieved remission with citalopram therapy, according to an article in the January 2006 issue of the American Journal of Psychiatry.

This real-world outcome study, led by Madhukar H. Trivedi, MD, investigated 2,876 US outpatients with nonpsychotic depression at 23 psychiatric and 18 primary care sites. Nearly 80 percent had chronic or recurrent major depression and comorbid medical and psychiatric conditions.

Patients in both settings achieved comparable remission or response rates---30 percent --- with a substantial number of patients achieving remission or response at or around eight weeks of treatment. The researchers used the selective serotonin reuptake inhibitor citalopram.

“This study raises the bar for studies of real life outcomes of treatment for depression by focusing on recovery rather than mere improvement of symptoms. The good and bad news is that 30 percent of patients achieve recovery during initial treatment. While we are pleased about the recovery of so many people, the question of how the majority who do not achieve recovery should be treated is of obvious concern,” said Robert Freedman, MD, journal editor-in-chief. “For now, the data offer new treatment guidelines for clinicians and realistic estimates of the likelihood of successful outcomes for their patients.”

Findings also showed there were differences in response rate based on demographic characteristics: Patients who were Caucasian, female, employed, or had higher levels of education or income had higher remission rates. In contrast, patients with comorbid disorders (especially anxiety or drug abuse) and general medical disorders had lower remission rates.

“This study should prompt both primary care physicians and psychiatrists to monitor their patient's response to treatment with brief assessment instruments. Currently available instruments such as the QIDS or PHQ-9 may be used to correctly identify and modify treatment for the two-thirds of patients who don't achieve remission with initial treatment,” said Darrel A. Regier, MD, MPH, director of the American Psychiatric Association’s Division of Research.

“The scope and design of this large National Institute of Mental Health study makes it a welcome addition to evidence-based treatment with significant practical utility for guiding clinical practice.”

QIDS is Quick Inventory of Depressive Symptomatology and PHQ-9 is Patient Health Questionnaire (nine questions).



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