STAR* D study: searching strategies regarding lack of response to an SSRI]

STAR*D, the biggest investigation ever conducted on the treatment of major depression, was aimed to determine prospectively which of several treatments is the most effective "next step" for patients who do not reach remission with an initial or subsequent treatment or who cannot tolerate the treatment. Its main findings show that: 1) Monotherapy remission rates are low; 2) There were no outcome differences in changing to another SSRI, to a dual reuptake inhibitor o to another mechanism of action. 3) Augmentation strategies worked perhaps better in patients with partial response and good citalopram tolerability. There was a slight advantage of bupropion over buspirone. T3 had better tolerability and was easier to use than lithium; 4) There was no difference between cognitive therapy as a switch or as augmentation strategy versus medication as a switch or augmentation strategy. Antidepressants were faster in augmentation. 5) There were no statistical differences in remission rates among any of the medications compared in this study; 6) Remission rates drop level after level, more substantially after two failed treatments. Conversely, recurrence rates rise progressively; 7) Patients who achieve remission are less likely to relapse than patients who have only responded.