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Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report.

OBJECTIVE: This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. METHOD: A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of or=11 (HRSD(17)>or=14) defined relapse. RESULTS: The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps. CONCLUSIONS: When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed.

Pubmed ID: 17074942


  • Rush AJ
  • Trivedi MH
  • Wisniewski SR
  • Nierenberg AA
  • Stewart JW
  • Warden D
  • Niederehe G
  • Thase ME
  • Lavori PW
  • Lebowitz BD
  • McGrath PJ
  • Rosenbaum JF
  • Sackeim HA
  • Kupfer DJ
  • Luther J
  • Fava M


The American journal of psychiatry

Publication Data

November 31, 2006

Associated Grants

  • Agency: NIMH NIH HHS, Id: N01MH90003

Mesh Terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care
  • Antidepressive Agents
  • Clinical Protocols
  • Cognitive Therapy
  • Combined Modality Therapy
  • Depressive Disorder, Major
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Personality Inventory
  • Psychiatric Status Rating Scales
  • Questionnaires
  • Secondary Prevention
  • Treatment Outcome