Antidepressant Effectiveness
STAR*D Study Results
STAR*D was an NIH-funded study and it stands for: Sequenced Treatment Alternatives to Relieve Depression. It was a seven-year study, involving more than 4,000 patients, making the largest and most definitive research we have available that underscores the inadequacies of currently available treatments.
Effectiveness of Antidepressant Trials
What the STAR*D study showed was that with each medication trial that a patient fails, the likelihood to respond to the next medication drops.
Tolerability of Antidepressants
At the same time, with each successive treatment trial, the likelihood of experiencing side effects increases.
Clearly, current antidepressant treatments do not result in a fully satisfactory outcome in a large proportion of patients with major depression.
References
- Fava, M., A. J. Rush, et al. (2006). "A Comparison of Mirtazapine and Nortriptyline Following Two Consecutive Failed Medication Treatments for Depressed Outpatients: A Star*D Report." Am J Psychiatry 163(7): 1161-1172.
- McGrath, P. J., J. W. Stewart, et al. (2006). "Tranylcypromine Versus Venlafaxine Plus Mirtazapine Following Three Failed Antidepressant Medication Trials for Depression: A STAR*D Report." Am J Psychiatry 163(9): 1531-1541.
- Nierenberg, A. A., M. Fava, et al. (2006). "A Comparison of Lithium and T3 Augmentation Following Two Failed Medication Treatments for Depression: A STAR*D Report." Am J Psychiatry 163(9): 1519-1530.
- Rush, A. J. (2007). "STAR*D: What have we learned?" Am J Psychiatry 164(2): 201-204.
- Rush, A. J., M. H. Trivedi, et al. (2006). "Acute and Longer-Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report." Am J Psychiatry 163(11): 1905-1917.
- Trivedi, M. H., M. Fava, et al. (2006). "Medication Augmentation after the Failure of SSRIs for Depression." New England Journal of Medicine 354(12): 1243-1252.
- Trivedi, M. H., A. J. Rush, et al. (2006). "Evaluation of Outcomes with Citalopram for Depression Using Measurement-Based Care in STAR*D Implications for Clinical Practice." Am J Psychiatry 163(1): 28-40
Depression Treatment Guidelines
APA Depression Treatment Guidelines
In 2010, the American Psychiatric Association updated their Practice Guidelines for the Treatment of Patients with Major Depressive Disorder. TMS is now included as an accepted treatment option for patients who have failed to benefit from first line treatment attempts.
The APA Treatment Guidelines recommend a stepwise approach for treatment-resistant depression. In terms of medications, this is accomplished with either switching or augmenting antidepressants. Even though there is literature on the benefits of these approaches, only some atypical antipsychotics have received FDA-approval as augmentation agents.
References:
- American Psychiatric Association (2010) (eds: Gelenberg, AJ, Freeman, MP, Markowitz, JC, Rosenbaum, JF, Thase, ME, Trivedi, MH, Van Rhoads, RS). Practice Guidelines for the Treatment of Patients with Major Depressive Disorder, 3rd Edition.
Reseach Literature
New Trial Data Confirm Clinical Effectiveness and Good Adherence Rates With NeuroStar TMS Therapy in Patients With Major Depressive Disorder Treated in a Real World Practice Setting - presented at the American Psychiatric Association Meeting in Hawaii, May 2011
Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study- published in Brain Stimulation, October 2010
Daily Left Prefrontal Transcranial Magnetic Stimulation Therapy for Major Depressive Disorder - A Sham-Controlled Randomized Trial published in the Archives of General Psychiatry, May 2010
Cost-effectiveness of Transcranial Magnetic Stimulation in the Treatment of Major Depression: A Health Economics Analysis - This study was published in Advances in Therapy, March 2009
Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: Clinical Predictors of Outcome in a Multisite, Randomized Controlled Clinical Trial - This study was published in the online version of Neuropsychopharmacology, August 2008
Transcranial Magnetic Stimulation in the Acute Treatment of Major Depressive Disorder: Clinical Response in an Open-Label Extension Trial - This study was published in The Journal of Clinical Psychiatry, March 2008
Transcranial Magnetic Stimulation in the Treatment of Major Depressive Disorder: A Comprehensive Summary of Safety Experience From Acute Exposure, Extended Exposure, and During Reintroduction Treatment - This article was published in The Journal of Clinical Psychiatry, February 2008
Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial - This study was published in Biological Psychiatry, December 2007
