STAR*D study Flashcards
what is STAR*D
Sequenced Treatment Alternatives to Relieve depression, a pragmatic real world trial in USAw
hat was the aim of STAR*D?
to assess the effectiveness of Rx in patients diagnosed with MDD
What was the Rx of level 1 in the STAR*D study?
Citalopram for 14 weeks
What was the Rx of level 2 in the STAR*D study?
Switch to Sertraline, Venlafaxine, Bupriopion and CBT
or
Augmentation with bupropion, buspirone or CBT
What was the Rx of level 3 in the STAR*D study?
Swapping to Mirtazapine or Nortriptyline
or
Add lithium or triiodothyronine (T3)
What was the Rx of level 4 in the STAR*D study?
swapping to tranylcypromine (MAOIs)
or
Combination of Venlafaxine & venlafaxine
what was the outcome in STAR*D study?
becoming symptom free
Inclusion criteria for STAR*D study?
- Non psychotic MDD
- 18-75 years
-≥14 on 17 items HAM-D
-No bipolar, OCD, ED or Seizure disorder
Rate of remission of depression at level one
35-40%
1/3
(extra 10-15% responded but not to remission level)
Rate of response in those who fail at level 1 and switch to another medication
1/4
rate of response in those who fail at level 1 and add to another medication
1/3
True or False
Both switching and augmenting are reasonable option if initial antidepressant failed.
True
How long Trial of antidepressant should take
8 weeks with at least moderately aggressive dose
when do we say treatment resistant depression?
when two antidepressant fail to induce remission
what happens to likelihood of remission when two vigorous Rx don’t work with depression?
it drops
