Results of a landmark study on depression provide conclusive evidence that treatment works and recovery is very possible for people who suffer from major, chronic depression. This study, called the “Sequenced Treatment Alternatives to Relieve Depression” study (STAR*D), is the largest multicenter study on major depression ever conducted. It was funded by the National Institute of Mental Health (NIMH).
Study results: The results of the study were released in two articles published in the
Were different results achieved with specific medications? No significant differences were found in the efficacy, safety or tolerability of the three medications administered to the group that switched medications. These medications included sertraline (Zoloft), bupropion-SR (Wellbutrin) and venlaxafine-XR (Effexor), different types of anti-depressants.
Some differences in results were found in the two medications administered to the group that added a second medication. Specifically, individuals administered bupropion-SR, an anti-depressant medication, experienced fewer symptoms, greater symptom relief and lower side effects than individuals administered buspirone, an anti-anxiety medication. However, one-third of individuals became symptom free within 14 weeks of using either of these medications.
Does the failure of one Selective Serotonin Reuptake Inhibitor (SSRI) to work mean that others won’t work?
Not necessarily. Significantly, some participants in the STAR*D study did not experience a reduction in symptoms when taking one SSRI (citalopram) but did experience reduction or full remission of their symptoms from a second SSRI (sertraline). This does not mean that sertraline is generally more effective than citalopram but rather what works best for one person may not work as well for another.
The results in STAR*D represent a significant step forward in the evolving understanding of how best to treat major depression. These results should inform legislators and policymakers grappling with important public policy decisions at federal and state levels.
In the words of John A. Rush, M.D., a principal investigator in the study, "Hang in there. If the first treatment does not relieve your symptoms, consider changing or adding another medication. Follow instructions from your doctor and don’t give up."
Proposed cuts to funding for the National Institute of Mental Health (NIMH) are ill-advised. More funding for research is needed to build on the promise engendered by studies such as STAR*D.
These studies are unique and unprecedented. As public, long-term, comparative, "real world" studies, they are different from those conducted by private industry.
They are essential to building a research and treatment "infrastructure" that can lead to newer, better medications and help consumers and family members and practitioners make better choices going forward. It is essential that NIMH continue funding such studies to keep the momentum going.
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