Clinically Relevant Findings from STAR*D
Authors: Rush A. John , Kilner Jon , Fava Maurizio , Wisniewski Stephen R. , Warden Diane , Nierenberg Andrew A. , Trivedi Madhukar H. 
Published: March 2009

<P>Major depressive disorder (MDD) is a highly prevalent and debilitating disease that often requires several treatment trials before achieving remission. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study was designed to determine which of several treatment options are most effective when initial and, if necessary, subsequent treatments do not produce remission. The research resulted in a variety of findings beyond the efficacy of treatment options. This article presents the main clinically relevant results from STAR*D (<A HREF="http://www.star-d.org" TARGET="_new">www.star-d.org</A>). </P> <H4>ABOUT THE AUTHORS</H4> <P>A. John Rush, MD, is with the Departments of Clinical Sciences and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas. Jon Kilner, MS, MA, is a professional medical and scientific writer and editor based in Pittsburgh, Pennsylvania. Maurizio Fava, MD, and Andrew A. Nierenberg, MD, are with the Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts. Stephen R. Wisniewski, PhD, is with the Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh School of Medicine. Diane Warden, PhD, MBA, and Madhukar H. Trivedi, MD, are with the Department of Psychiatry, University of Texas Southwestern Medical Center. </P> <P>Address correspondence to: A. John Rush, MD, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas (UT Southwestern), 5323 Harry Hines Blvd., Dallas, TX 75390-9066; fax 214-648-6863; or e-mail: <A HREF="mailto:john.rush@utsouthwestern.edu">john.rush@utsouthwestern.edu</A>. </P> <P>Dr. Rush disclosed the following relevant financial relationships: Advanced Neuronetic Systems, AstraZeneca, Best Practice Project Management, Bristol-Myers Squibb, Cyberonics, Forest Pharmaceuticals, Gerson Lehman Group, GlaxoSmithKline, Healthcare Technology Systems, Jazz Pharmaceuticals, Eli Lilly and Company, Magellan Health Services, Merck and Co., Neuronetics, Ono Pharmaceutical, Organon USA, Personality Disorder Research Corp., Pfizer, The Urban Institute, and Wyeth-Ayerst Laboratories: Advisor/Consultant; Pfizer: Equity Holdings (excluding mutual funds/blinded trusts); Robert Wood Johnson Foundation, the National Institute of Mental Health, the Stanley Medical Research Institute: Research support recipient; Guilford Publications, Healthcare Technology Systems: Royalties/patents, other income; and Cyberonics, Forest Pharmaceuticals, GlaxoSmithKline, Eli Lilly and Company, and Merck: Speakers&#39; Bureau. Mr. Kilner has disclosed no relevant financial relationships. Dr. Fava disclosed the following relevant financial relationships: Aspect Medical Systems; Astra-Zeneca, Bayer AG, Biovail Pharmaceuticals, BrainCells Inc., Bristol-Myers Squibb, Cephalon, Compellis, Cypress Pharmaceuticals, Dov Pharmaceuticals, EPIX Pharmaceuticals, Fabre-Kramer Pharmaceuticals, Forest Pharmaceuticals, GlaxoSmithKline, Grunenthal GmBH, Johnson and Johnson Pharmaceuticals, Janssen Pharmaceutica, Jazz Pharmaceuticals, Knoll Pharmaceutical Company, Eli Lilly and Company, Lundbeck, MedAvante, Novartis, Nutrition 21, Organon, PamLab, Pfizer, PharmaStar, Pharmavite, Roche, Sanofi/Synthelabo, Sepracor, Solvay Pharmaceuticals, Somerset Pharmaceuticals, and Wyeth-Ayerst Laboratories: Advisor/Consultant; Aspect Medical Systems, Astra-Zeneca, Bayer AG; Biovail Pharmaceuticals, BrainCells Inc., Bristol-Myers Squibb, Cephalon, Compellis, Cypress Pharmaceuticals, Dov Pharmaceuticals, Epix Pharmaceuticals, Fabre-Kramer Pharmaceuticals; Forest Pharmaceuticals, GlaxoSmithKline, Grunenthal GmBH, Johnson and Johnson Pharmaceuticals, Janssen Pharmaceutica, Jazz Pharmaceuticals: Advisor/Consultant; Compellis, MedAvante: Equity Holdings (excluding mutual funds/blinded trusts); Abbott Laboratories, Alkermes, Aspect Medical Systems, Astra-Zeneca, Bristol-Myers Squibb, Cephalon, Forest Pharmaceuticals, GlaxoSmithKline, Johnson and Johnson, Lichtwer Pharma GmbH; Eli Lilly and Company, Lorex Pharmaceuticals, Novartis, Organon, PamLab, Pfizer, Pharmavite, Roche, Sanofi/Synthelabo, Solvay Pharmaceuticals, and Wyeth-Ayerst Laboratories: Research support recipient; and Astra-Zeneca, Bristol-Myers Squibb, Cephalon, Forest Pharmaceuticals, GlaxoSmithKline, Eli Lilly and Company, Novartis, Organon, Pfizer, PharmaStar, and Wyeth-Ayerst: Speakers&#39; Bureau. Dr. Wisniewski has disclosed the following relevant financial relationships: Cyberonics: Advisor/Consultant; and National Institute of Mental Health: Research support recipient. Dr. Warden has disclosed the following relevant financial relationships: Bristol Myers Squib and Pfizer: Equity holdings; and National Institute of Mental Health, National Institute of Drug Abuse, National Alliance for Research in Schizophrenia and Depression ( NARSAD): Research support recipient. Dr. Nierenberg has disclosed the following relevant financial relationships: Bristol-Myers Squibb, Eli Lilly and Company, Genaissance, GlaxoSmithKline, Innapharma, Neuronetics, Pfizer, Sepracor, and Shire: Advisor/Consultant; Bristol-Myers Squibb; Cederroth, Cyberonics, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Lichtwer Pharma, Eli Lilly and Company, Pfizer, National Institute of Mental Health; NARSAD, Stanley Foundation, and Wyeth-Ayerst Laboratories: Research support recipient; and Eli Lilly and Company, GlaxoSmithKline, Organon, and Wyeth-Ayerst Laboratories: Speakers&#39; bureau. Dr. Trivedi has disclosed the following relevant financial relationships: Abbott Laboratories, Akzo (Organon Pharmaceuticals), Bayer; Bristol-Myers Squibb, Cyberonics, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Johnson and Johnson, Eli Lilly and Company, Meade Johnson, Parke-Davis Pharmaceuticals, Pfizer, Pharmacia and Upjohn, Sepracor, Solvay Pharmaceuticals, Wyeth-Ayerst Laboratories: Advisor/Consultant; Bristol-Myers Squibb, Cephalon, Corcept Therapeutics, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutica, National Institute of Mental Health, NARSAD, Pfizer, Predix Pharmaceuticals, and Wyeth-Ayerst Laboratories: Research support recipient; and Akzo (Organon Pharmaceuticals); Bristol-Myers Squibb, Cyberonics, Forest Pharmaceuticals, Janssen Pharmaceutica, LP; Eli Lilly and Company, Pharmacia and Upjohn, Solvay Pharmaceuticals, and Wyeth-Ayerst Laboratories: Speaker&#39;s Bureau. </P> <P>The STAR*D project was funded by the National Institute of Mental Health under Contract N01MH90003 to UT Southwestern Medical Center at Dallas (P.I.: A.J. Rush). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. </P> <P>The authors appreciate the support of Bristol Myers Squibb, Forest Laboratories, GlaxoSmithKline, King Pharmaceuticals, Organon, Pfizer, and Wyeth for providing medications at no cost for the STAR*D trial. </P> <H4>EDUCATIONAL OBJECTIVES</H4> <OL> <LI> Identify the principles and practice of measurement-based care. </LI> <LI>Discuss the likely remission rates among depressed patients with various degrees of treatment resistance.</LI> <LI>Explain the expected longer-term relapse rates in relation to the number of failed acute treatments.</LI> </OL>