Can Phase III Trial Results of Antidepressant Medications Be Generalized to Clinical Practice? A STAR*D Report
Abstract
OBJECTIVE: Phase III clinical trials for depression enroll participants with major depressive disorder according to stringent inclusion and exclusion criteria. These patients may not be representative of typical depressed patients seeking treatment. This analysis used data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project--which used broad inclusion and minimal exclusion criteria--to evaluate whether phase III clinical trials recruit representative depressed outpatients. METHOD: Of 2,855 participants, 22.2% met typical entry criteria for phase III clinical trials (efficacy sample) and 77.8% did not (nonefficacy sample). These groups were compared regarding baseline sociodemographic and clinical features and the characteristics and outcomes of acute-phase treatment. RESULTS: The efficacy sample had a shorter average duration of illness and lower rates of family history of substance abuse, prior suicide attempts, and anxious and atypical symptom features. Despite similar medication dosing and time at exit dose, the efficacy participants tolerated citalopram better. They also had higher rates of response (51.6% versus 39.1%) and remission (34.4% versus 24.7%). These differences persisted even after adjustments for baseline differences. CONCLUSIONS: Phase III trials do not recruit representative treatment-seeking depressed patients. Broader phase III inclusion criteria would increase the generalizability of results to practice, potentially reducing placebo response and remission rates (reducing the risk of failed trials) but at the risk of some increase in adverse events.
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In the STAR*D trial, 77.8% of the patients would have been excluded in conventional clinical trials.
“Results from a large trial conducted in a clinical setting (the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial) showed that 77.8% of the patients in the STAR*D trial would have been excluded in conventional clinical trials.”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [42]
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“%) compared to controls (41%), in agreement with female overrepresentation in most MDD studies (Wisniewski et al. 2009).”
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“Included participants are less impaired and have a higher level of functioning (36, 37), and it has been demonstrated that they respond better to antidepressants than the average real-world patient (36).”
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“In one of the largest effectiveness studies, the STAR*D study, this thesis has been confirmed by comparison of a patient sub-sample matching all usual criteria of RCTs (the so-called efficacy sample) with patients meeting the broader inclusion criteria of the effectiveness study who showed a different clinical profile…”
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The use of referenced-EEG (rEEG) in assisting medication selection for the treatment of depression
DeBattista, C., Kinrys, G., Hoffman, D. A., Goldstein, C., Zajecka, J., Kocsis, J. H., Teicher, M. H., Potkin, S. G., Preda, A., Multani, G., et al. (2010) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.05.009 · Cited by 49 · see citing works
Hengartner, M. P. (2019) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2019-111161 · Cited by 48 · see citing works
“However, note that this remission rate for SSRI is exaggerated, because industrysponsored efficacy trials carefully preselect the participants who are most likely to respond favourably to drug treatment.(18) In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial,(19) which enrolled the largest an…”
BackgroundZimmerman, M. A., Balling, C. E., Chelminski, I., & Dalrymple, K. L. (2019) · Psychotherapy and Psychosomatics · doi:10.1159/000499917 · Cited by 46 · see citing works
Defining the Role of Pharmacology in the Emerging World of Translational Research
Enna, S. J., & Williams, M. J. (2009) · Advances in pharmacology · doi:10.1016/s1054-3589(08)57001-3 · Cited by 43 · see citing works
Morningness – eveningness and treatment response in major depressive disorder
Corruble, E., Frank, E., Gressier, F., Courtet, P., Bayle, F., Llorca, P., Vaïva, G., & Gorwood, P. A. P. M. (2013) · Chronobiology International · doi:10.3109/07420528.2013.834924 · Cited by 43 · see citing works
“treatment (Trivedi et al., 2004, 2006; Wisniewski et al., 2009), as well as to other studies in depressed patients (Gaspar-Barba et al.”
Resultvan der Lem, R., de Wever, W. W., van der Wee, N. J., van Veen, T., Cuijpers, P., & Zitman, F. G. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-192 · Cited by 37 · see citing works
“Some studies showed that eligible patients had a better treatment outcome than non-eligible patients in routine outpatient care [8].”
BackgroundThe Efficacy of Psychotherapy: Focus on Psychodynamic Psychotherapy as an Example
Levy, K. N., Ehrenthal, J. C., Yeomans, F. E., & Caligor, E. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.377 · Cited by 40 · see citing works
“%) when compared with patients who did not have comorbidity (Wisniewski et al., 2009).”
BackgroundResultStar-D: lessons learned and future implications
Rush, A. J. (2011) · Depression and Anxiety · doi:10.1002/da.20841 · Cited by 39 · see citing works
“In fact, the STAR D results suggested that one could safely widen the inclusion criteria in such registration trials, thereby enhancing generalizability[5] and potentially the validity of the outcomes to be expected of these agents if they are subsequently marketed.”
BackgroundInfluentialSelf-citationSampling bias in an internet treatment trial for depression
Donkin, L., Hickie, I. B., Christensen, H., Naismith, S. L., Neal, B., Cockayne, N. L., & Glozier, N. (2012) · Translational Psychiatry · doi:10.1038/tp.2012.100 · Cited by 38 · see citing works
Bschor, T., & Kilarski, L. L. (2016) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2016.1155985 · Cited by 38 · see citing works
“deliberately designed so that everyday patients would be included, showed that only 22% of study participants would have met the inclusion criteria of a typical placebo-controlled efficacy study; however, it was these patients that showed significantly better performance [49].”
BackgroundHowland, R. H. (2009) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s5453 · Cited by 38 · see citing works
“Dovepress “Real world” patients in general practice are likely to be quite different than the patients enrolled in clinical trials.(70) As a result, the relative safety of agomelatine is unknown when used in patients who might have undetected liver impairment or liver disease or in patients who are at risk for develop…”
Pedrelli, P., Iovieno, N., Vitali, M., Tedeschini, E., Bentley, K. H., & Papakostas, G. I. (2011) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e31822c0adf · Cited by 37 · see citing works
Trivedi, M. H., Fatt, C. C., Jha, M. K., Cooper, C. M., Trombello, J. M., Mason, B. L., Hughes, J. L., Gadad, B. S., Czysz, A. H., Toll, R. T., et al. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.12.004 · Cited by 37 · see citing works
Self-citationMcWilliams, N. (2011) · Journal of Personality Assessment · doi:10.1080/00223891.2011.542709 · Cited by 36 · see citing works
“Interestingly, in an empirical investigation of a parallel problem in psychopharmacology, Wisniewski et al. (2009) concluded that “representative treatment-seeking patients” are not included in Phase III drug trials.”
BackgroundEvaluating treatments in health care: The instability of a one-legged stool
Kaplan, B. J., Giesbrecht, G. F., Shannon, S. M., & McLeod, K. (2011) · BMC Medical Research Methodology · doi:10.1186/1471-2288-11-65 · Cited by 34 · see citing works
“The study known as the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) is a well-known, multicentre prospective trial of medications for major depressive disorder [12].”
BackgroundLee, J. C., Wilson, A. C., Corlier, J., Tadayonnejad, R., Marder, K. G., Pleman, C. M., Krantz, D., Wilke, S. A., Levitt, J. G., Ginder, N., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.011 · Cited by 28 · see citing works
“The level of experimental control in our study, however, was comparable to that of other real-world studies of treatment-resistant depression such as the STAR*D trial (Wisniewski et al., 2009).”
Köhler, S., Hoffmann, S., Unger, T., Steinacher, B., Dierstein, N., & Fydrich, T. (2011) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.795 · Cited by 33 · see citing works
“Only 22% of the patients included in STAR*D would have met the criteria of an RCT (Wisniewski et al., 2009).”
BackgroundChanges in Depression Subtypes Among Men in STAR*D: A Latent Transition Analysis
Ulbricht, C. M., Dumenci, L., Rothschild, A. J., & Lapane, K. L. (2015) · American Journal of Men s Health · doi:10.1177/1557988315607297 · Cited by 33 · see citing works
Kolber, M. R., Korownyk, C. S., Young, J. C., Garrison, S., Kirkwood, J. E. M., & Allan, G. M. (2023) · Canadian Family Physician · doi:10.46747/cfp.6904269 · Cited by 32 · see citing works
Takaba, R., Ibi, D., Yoshida, K., Hosomi, E., Kawase, R., Kitagawa, H., Goto, H., Achiwa, M., Mizutani, K., Maeda, K., et al. (2023) · Naunyn-Schmiedeberg s Archives of Pharmacology · doi:10.1007/s00210-023-02778-x · Cited by 32 · see citing works
“Additionally, existing antide-pressants require chronic dosing for several weeks, leading to an increased risk of adverse effects such as serotonin syndrome; i.e., altered mental status, autonomic hyperactivity, and neuromuscular abnormalities (Wisniewski et al. 2009; Foong et al. 2018).”
Depression in Premenopausal Women With HSDD
Clayton, A. H., Maserejian, N. N., Connor, M. K., Huang, L., Heiman, J. R., & Rosen, R. C. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31824c4c89 · Cited by 32 · see citing works
“Neutral 147 (21) 81 (22) 44 (28) 37 (18)”
BackgroundInfluentialUlbricht, C. M., Rothschild, A. J., & Lapane, K. L. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.039 · Cited by 31 · see citing works
Under the Influence: The Interplay among Industry, Publishing, and Drug Regulation
Cosgrove, L., Vannoy, S. D., Mintzes, B. J., & Shaughnessy, A. F. (2016) · Accountability in Research · doi:10.1080/08989621.2016.1153971 · Cited by 31 · see citing works
“The lowest price for a month’s supply of vortioxetine is USD 253.55; the antidepressants used as active comparators in the RCTs—duloxetine and venlafaxine—are available as generics and cost from USD 14.40 to USD 52.25 per month (Goodrx.com, 2015).”
BackgroundInfluentialPeeters, F. P. M. L., Huibers, M. J. H., Roelofs, J., van Breukelen, G., Hollon, S. D., Markowitz, J. C., van Os, J., & Arntz, A. R. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.08.022 · Cited by 30 · see citing works
“The effectiveness of community PHT in comparison to efficacy estimates varies widely among studies (Rush et al., 2004; Wisniewski et al., 2009).”
BackgroundResultInfluentialKatz, A. J., Dusetzina, S. B., Farley, J. F., Ellis, A. R., Gaynes, B. N., Castillo, W. C., Stürmer, T., & Hansen, R. A. (2012) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/j.1875-9114.2011.01020.x · Cited by 30 · see citing works
“The patients were aged 18–75 years, and some had multiple comorbid medical and psychiatric illnesses.(26) The distribution of depressive severity reflected that found in nationally representative samples of patients with depression,(27) and the racial and ethnic composition of the enrolled patients approximated that o…”
BackgroundSelf-citationDetection of suicidality from medical text using privacy-preserving large language models
Wiest, I. C., Verhees, F. G., Ferber, D., Zhu, J., Bauer, M., Lewitzka, U., Pfennig, A., Mikoláš, P., & Kather, J. N. (2024) · The British Journal of Psychiatry · doi:10.1192/bjp.2024.134 · Cited by 31 · see citing works
“17 Other clinical applications could include prediction and early warning of deterioration in symptom severity and a subsequent need for escalation of therapy, such as involuntary admission, restraint or forcible medication.”
Scherf‐Clavel, M., Weber, H., Wurst, C., Stonawski, S., Hommers, L. G., Unterecker, S., Wolf, C., Domschke, K., Rost, N., Brückl, T. M., et al. (2022) · Pharmacopsychiatry · doi:10.1055/a-1872-0613 · Cited by 27 · see citing works
“However, it is not clear if results emerging from RCTs with commercial kits are relevant for clinical settings; for example, due to restrictions in inclusion criteria and therapy protocols [3, 13] and even more so, which genes are relevant.”
Scheifes, A., Stolker, J. J., Egberts, T. C. G., Nijman, H. L. I., & Heerdink, E. R. (2010) · Journal of Intellectual Disability Research · doi:10.1111/j.1365-2788.2010.01353.x · Cited by 27 · see citing works
Combining Antidepressant Medications: A Good Idea?
Rush, A. J. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09121768 · Cited by 27 · see citing works
Self-citationBaghai, T. C., Blier, P., Baldwin, D. S., Bauer, M., Goodwin, G. M., Fountoulakis, K. N., Kasper, S. F., Leonard, B. E., Malt, U. F., Stein, D. J., et al. (2011) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-011-0274-7 · Cited by 26 · see citing works
“There are some conflicting results in studies investigating response or remission rates of RCTs in comparison with naturalistic clinical data [104, 123], which may be potentially different due to an artificial patient selection for highly regulated clinical trials.”
Blais, M. A., Malone, J. C., Stein, M. B., Slavin‐Mulford, J. M., O’Keefe, S. M., Renna, M. E., & Sinclair, S. J. (2013) · Psychotherapy · doi:10.1037/a0031385 · Cited by 25 · see citing works
“In fact it has been estimated that fewer than 30% of real world patients would qualify for inclusion into either an RCT pharmacotherapy study (Wisniewski et al., 2009) or psychotherapy study (Minami et al.”
BackgroundBengtson, A. M., Pence, B. W., Gaynes, B. N., Quinlivan, E. B., Heine, A. D., O’Donnell, J. K., Crane, H. M., Mathews, W. C., Moore, R. D., Westreich, D. J., et al. (2016) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001131 · Cited by 25 · see citing works
Self-citationHow should we design future mechanistic and/or efficacy clinical trials?
D, M. F. M. (2023) · Neuropsychopharmacology · doi:10.1038/s41386-023-01600-9 · Cited by 26 · see citing works
Hoertel, N., López, S., Wang, S., González-Pinto, A. M., Limosin, F., & Blanco, C. (2015) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000091 · Cited by 24 · see citing works
“In addition, a previous study (Wisniewski et al., 2009) showed that some exclusion criteria in clinical trials may be predictors of poor treatment outcomes, suggesting that increasing generalizability of results to practice could potentially reduce placebo response and remission rates (decreasing…”
Kirsch, I., Huedo-Medina, T. B., Pigott, H. E., & Johnson, B. T. (2018) · Psychology of Consciousness: Theory, Research, and Practice · doi:10.1037/cns0000164 · Cited by 24 · see citing works
Closed Testing in Pharmaceutical Research: Historical and Recent Developments
Henning, K. S. S., & Westfall, P. H. (2015) · Statistics in Biopharmaceutical Research · doi:10.1080/19466315.2015.1004270 · Cited by 23 · see citing works
“Concerns over the efficacy of drugs, especially psychiatric medication, fuel costly lawsuits and public concern over the nature of the clinical trials process (Graham 2006; Mallinckrodt 2006; Dyer 2007; Wisniewski et al. 2009; Wilson 2010).”
BackgroundDiscontinued psychiatric drugs in 2008
Kirchhoff, V., Nguyen, H. T., Soczynska, J. K., Woldeyohannes, H. O., & McIntyre, R. S. (2009) · Expert Opinion on Investigational Drugs · doi:10.1517/13543780903184591 · Cited by 22 · see citing works
“This disquieting reality is reified by results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D), Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trials that reported suboptimal outcomes for most enro…”
ResultDistinguishing Functional From Syndromal Recovery: Implications for Clinical Care and Research
Rush, A. J. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.15com09859 · Cited by 22 · see citing works
Self-citationWarden, D., Trivedi, M. H., Greer, T. L., Nunes, E. V., Grannemann, B. D., Horigian, V. E., Somoza, E. C., Ring, K. M., Kyle, T. L., & Szapocznik, J. (2011) · Contemporary Clinical Trials · doi:10.1016/j.cct.2011.08.011 · Cited by 22 · see citing works
“Clinical research networks [4], such as those for cancer or cardiovascular diseases [5,6], psychiatric disorders [7–9] and substance abuse [10] allow for the conduct of trials in realworld populations that are more generalizable than the typical efficacy samples recruited in research settings [11].”
BackgroundSelf-citationRedundant, Secretive, and Isolated: When Are Clinical Trials Scientifically Valid?
Borgerson, K. (2014) · Kennedy Institute of Ethics journal · doi:10.1353/ken.2014.0029 · Cited by 21 · see citing works
Measuring Outcomes in Adult Outpatient Psychiatry
Blais, M. A., Sinclair, S. J., Baity, M. R., Worth, J. L., Weiss, A. P., Ball, L. A., & Herman, J. B. (2011) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.749 · Cited by 21 · see citing works
“Real world patients not meeting RCT inclusion criteria typically have less robust responses to pharmacotherapy (Wisniewki et al., 2009), psychotherapy and combined treatment (Minami et al.”
Choice of Treatment with Antidepressants: Influencing Factors
Himmerich, H., & Wranik, D. W. (2012) · Current Pharmaceutical Design · doi:10.2174/138161212803523653 · Cited by 21 · see citing works
Efficacy of antidepressants: bias in randomized clinical trials and related issues
Wang, S.-M., Han, C., Lee, S.-J., Jun, T.-Y., Patkar, A. A., Masand, P. S., & Pae, C.-U. (2018) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2017.1377070 · Cited by 20 · see citing works
“One of the authors was involved in a multicenter DBRPCT about a decade ago.”
MethodInfluentialVilches, S., Tuson, M., Vieta, E., Álvarez, E., & Espadaler, J. (2019) · Pharmaceutics · doi:10.3390/pharmaceutics11090453 · Cited by 21 · see citing works
“This is supported by the observation of significant differences on intrinsic antidepressant efficacy between trials conducted under naturalistic conditions and those conducted with highly selected, phase-III-like patient populations [22].”
ResultClinical drug trials in general practice: how well are external validity issues reported?
Brænd, A. M., Straand, J., & Klovning, A. (2017) · BMC Family Practice · doi:10.1186/s12875-017-0680-7 · Cited by 19 · see citing works
“This has been demonstrated for several therapeutic areas, including diabetes [9], chronic obstructive pulmonary disease (COPD) [10], asthma [11], infectious diseases [12], and depression [13].”
BackgroundTreatment Resistance and Psychodynamic Psychiatry: Concepts Psychiatry Needs from Psychoanalysis
Plakun, E. M. (2012) · Psychodynamic Psychiatry · doi:10.1521/pdps.2012.40.2.183 · Cited by 19 · see citing works
“For example, in a reanalysis of the STAR*D data, Wisniewski et al. (2009) found that, despite similar medication dosing, those patients without comorbidity tolerated medication better, had higher rates of treatment response (52% vs.”
MethodGaynes, B. N., Warden, D., Trivedi, M. H., Wisniewski, S. R., D, M. F. M., & Rush, A. J. (2012) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.10.4.510 · Cited by 18 · see citing works
Self-citationSylvia, L. G., Hearing, C. M., Montana, R. E., Gold, A. K., Walsh, S. L., JANOS, J. A., Tovey, R. E., Deckersbach, T., & Nierenberg, A. A. (2018) · Medical Care · doi:10.1097/mlr.0000000000000789 · Cited by 17 · see citing works
Self-citationBurning issues in the meta-analysis of pharmaceutical trials for depression
Fountoulakis, K. Ν., Samara, M. T., & Siamouli, M. (2013) · Journal of Psychopharmacology · doi:10.1177/0269881113504014 · Cited by 17 · see citing works
“It is well known that patients recruited in RCTs do not correspond to the average real-life patient and because of this, the generalizability of the results is problematic (Licht et al., 1997; Partonen et al., 1996; Talamo et al., 2008; Van der Lem et al., 2010; Wisniewski et al., 2009; Zetin and Hoepner, 2007; Zimmer…”
BackgroundPsychodynamic Psychiatry, the Biopsychosocial Model, and the Difficult Patient
Plakun, E. M. (2018) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2018.01.007 · Cited by 17 · see citing works
Ulbricht, C. M., Dumenci, L., Rothschild, A. J., & Lapane, K. L. (2016) · Archives of Women s Mental Health · doi:10.1007/s00737-016-0606-8 · Cited by 16 · see citing works
Improving study design for antidepressant effectiveness assessment
Naudet, F., Millet, B., Reymann, J. M., & Falissard, B. (2013) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1391 · Cited by 15 · see citing works
Outcome in depression (II): beyond the Hamilton Depression Rating Scale
Demyttenaere, K., Kiekens, G., Bruffaerts, R., Mortier, P., Gorwood, P., Martin, L., & Di Giannantonio, M. (2021) · CNS Spectrums · doi:10.1017/s109285292000142x · Cited by 16 · see citing works
Ball, S. G., Dellva, M. A., D’Souza, D. N., Marangell, L. B., Russell, J. M., & Goldberger, C. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.06.006 · Cited by 15 · see citing works
Becker, R. E., Seeman, M. V., Greig, N. H., & Lahiri, D. K. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00214-x · Cited by 15 · see citing works
Symptom Severity and the Generalizability of Antidepressant Efficacy Trials
Zimmerman, M. A., Clark, H., Multach, M. D., Walsh, E. K., Rosenstein, L. K., & Gazarian, D. (2016) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000466 · Cited by 15 · see citing works
- Authors
- Wisniewski, S. R., Rush, A. J., Nierenberg, A. A., Gaynes, B. N., Warden, D., Luther, J. F., McGrath, P. J., Lavori, P. W., Thase, M. E., Fava, M., & Trivedi, M. H.
- Affiliations
- University of Pittsburgh (US)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2009-05
- Volume
- 166
- Issue
- 5
- Pages
- 599-607
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2124136543
- Cited by
- 223
- References
- 28
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 10 · 2022: 8 · 2021: 6 · 2020: 6 · 2019: 10 · 2018: 14 · 2017: 17 · 2016: 14 · 2015: 27 · 2014: 12 · 2013: 12 · 2012: 27
- FWCI
- 17.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01mh90003-26-0-0)
- National Institute of Mental Health (N01‐MH‐90003)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, antidepressants, citalopram, STAR*D, trial representativeness, placebo response, remission, response rate, outpatients
- MeSH terms
- Adult, Demography, Depressive Disorder, Major, Major Depressive Disorder, Drug Administration Schedule, Female, Humans, Male, Practice Patterns, Physicians', Surveys and Questionnaires, Remission Induction, Severity of Illness Index, Time Factors, Citalopram, Selective Serotonin Reuptake Inhibitors, Diagnostic and Statistical Manual of Mental Disorders
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