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The STAR*D Trial: Revealing the Need for Better Treatments

Dr. Insel is director and Dr. Wang is deputy director of the National Institute of Mental Health, 6001 Executive Blvd., Rm. 8235, MSC 9669, Bethesda, MD 20892-9669 (e-mail: insel{at}mail.nih.gov). This commentary is part of a special section on the STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression) and the implications of its findings for practice and policy. Grayson S. Norquist, M.D., M.S.P.H., served as guest editor of the special section.

STAR*D (Sequenced Treatment Alternatives to Relieve Depression) continues to stimulate debate. The landmark trial demonstrated the feasibility of large-scale, community-based studies conducted without pharmaceutical company support. The results provided insight into nonresponse to initial treatment with selective serotonin reuptake inhibitors and alternatives for second- and third-line treatment options and suggested opportunities for personalized approaches to depression care. However, initial and one-year remission rates (28% and 70%, respectively) suggest that important goals for treatment of this disabling disease remain out of reach and that the bar for antidepressants has been set far too low.

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				G. S. Norquist Introduction to the STAR*D Special Section Psychiatr Serv, November 1, 2009; 60(11): 1437 - 1438. [Full Text] [PDF]

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