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STAR*D
About the Trial
The Sequenced Treatment Alternatives to Relieve Depression study enrolled 4,041 outpatients with major depression and followed a four step algorithm starting with citalopram. Cumulative remission reached 67 percent across steps, but each successive step added less, and relapse was common. Switching and augmentation strategies, bupropion, sertraline, venlafaxine, cognitive therapy, all worked about equally. STAR*D, the largest prospective depression treatment trial, replaced marketing narratives with practical data: no magic second step exists, measurement based care and persistence matter. Its long term follow ups, and later reanalyses questioning outcome reporting, also taught the field about transparency in trial data.
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