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The STAR*D trial: revealing the need for better treatments

Thomas R Insel1, Philip S Wang

  • 1National Institute of Mental Health, Bethesda, MD 20892-9669, USA. insel@mail.nih.gov

Psychiatric Services (Washington, D.C.)
|November 3, 2009
PubMed

Insights

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial showed large-scale depression studies are feasible without drug company funding. Despite insights into treatment options, remission rates suggest current antidepressant therapies may be insufficient for many patients.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is a significant study in depression research.
  • It explored the feasibility of large-scale, community-based clinical trials.
  • The trial was notable for being conducted without pharmaceutical industry funding.

Purpose of the Study:

  • To investigate treatment options for major depressive disorder.
  • To provide insights into nonresponse to initial antidepressant treatment.
  • To explore alternatives for second- and third-line depression treatment.
  • To identify opportunities for personalized depression care.

Main Methods:

  • Conducted a large-scale, community-based study.
  • Evaluated selective serotonin reuptake inhibitors (SSRIs) as initial treatment.
  • Assessed alternative treatments for non-responders.

Main Results:

  • Demonstrated feasibility of large-scale, independent clinical trials.
  • Provided data on nonresponse to SSRIs and effectiveness of subsequent treatments.
  • Achieved initial remission rates of 28% and one-year remission rates of 70%.

Conclusions:

  • STAR*D highlighted the need for more effective depression treatments.
  • The study suggests current remission rates indicate unmet treatment needs.
  • Findings support further research into personalized depression management and improved antidepressant efficacy.

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