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ASCP Corner: Sequenced Treatment Alternatives to Relieve Depression (STAR*D): Lessons Learned

J Clin Psychiatry 2008;69(7):1184-1185

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Sequenced Treatment Alternatives to Relieve Depression (STAR*D), the largest prospective, randomized antidepressant treatment trial to date in outpatients with major depressive disorder (MDD) recruited from real-world clinical settings, enrolling 4011 outpatients aged 18 to 75 years with nonpsychotic MDD. Designed to determine which treatments are most effective after nonremission or intolerance to an initial selective serotonin reuptake inhibitor (SSRI), or to any of a series of subsequent randomized treatments, STAR*D was conducted in 18 primary and 23 psychiatric care settings across the United States. This review summarizes unique features of the study, initial remission rates and associated participant characteristics, remission rates for subsequent treatment steps, relapse rates during follow-up, and clinical implications.​