Gillian Maguire's List: DEPRESSION

• There are numerous drugs to choose from but no clear evidence of the superiority of one drug over another (9,10). In addition, efficacy of all the second-generation antidepressants has been less than optimal; studies have shown that after first-line treatment with these agents only about 60% of patients achieve a response and only 40% achieve remission (9,10,11).
• STAR*D findings are especially important for payers because the trial focused on patients whose first-line treatment had failed and for whom there was little evidence on which to base decisions about further treatment. In addition, STAR*D was an effectiveness trial, and the applicability of findings to real-world patients is high (for example, two-thirds of patients in the trial had a concurrent medical condition).
• Whereas the ARTIST trial (A Randomized Trial Investigating SSRI Treatment) (11) was the first large effectiveness trial of first-line treatments for depression, STAR*D is the first large high-quality effectiveness trial of second- and third-line pharmacologic treatments for depression, and it provided valuable information to both clinicians and payers. STAR*D findings add substantially to the body of evidence informing the treatment of depression in real-world settings. Previous research had shown no substantial differences among second-generation antidepressants used for first-line treatment. However, STAR*D showed the same to be true when these medications are used for second- and third-line treatments. STAR*D findings support the general lack of superiority of one drug over another. Also, in terms of the incidence of overall harmful effects, no drug was superior to another, although specific adverse effects were found to differ between drugs.

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