Treatment for Depression with Third of Participants Reaching Remission

Phase one of a four-phase, six-year study on treatments for depression – the largest of its kind and led by researchers at UT Southwestern Medical Center – showed nearly half fully recovered from their symptoms or had major improvement after treatment with an antidepressant medication.

Results of the study, involving nearly 3,000 patients at 41 sites, appear in the January issue of the American Journal of Psychiatry, include:

• A third of patients with major depressive disorder (MDD), when initially treated with a class of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI) using specific guidelines and dosage amounts, fully recovered from their symptoms. Another 10 percent to 15 percent showed a response to the medication, or reduction of at least half their symptoms.

• Patients suffering from depression responded similarly whether treated by a primary-care doctor or a psychiatrist when both followed the same treatment strategies.

• Study participants – who were treated in "real-world" clinics for depression, as well as other medical and psychiatric conditions – responded similarly to medication as did individuals in earlier clinical trials who volunteered for studies and typically had no other medical problems.

• The highest response and remission rates came from study participants who were Caucasian, female, employed, and had higher levels of education or income.
While additional results are yet to be published from phase two through phase four of the $35 million clinical trial designated STAR*D (Sequenced Treatment Alternatives to Relieve Depression), these first findings are significant because of the size and scope of the study, and because there is limited information currently available on successfully treating people with depression. STAR*D was funded by the National Institute of Mental Health (NIMH).

STAR*D was designed to focus on "real-world" patients with depression and help determine the most effective treatment strategies, particularly when individuals didn't respond to the first antidepressant medication tried. While there are numerous effective treatment options for depression – including nearly 20 Food and Drug Administration-approved antidepressants and several scientifically tested psychotherapies – no one treatment universally works. And, many people do not experience a satisfactory result from the first treatment used.

"STAR*D is important because it represents the largest group of moderately to severely depressed patients studied, most of whom had either chronic or recurrent major depression, and the majority of whom also had concurrent other general medical or psychiatric disorders," said Dr. A. John Rush, vice chairman for research in psychiatry at UT Southwestern and STAR*D's principal investigator.

"What's also important is that nearly half of these patients significantly benefited from and showed a response to the medication, with one in three of those achieving a symptom-free state, after the first round of medication," Dr. Rush said.