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).
|