The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: A Review

Sinyor, Mark; Schaffer, Ayal; Levitt, Anthony

doi:10.1177/070674371005500303

Cited by 396Treatment of Major DepressionMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: A Review

Sinyor, Mark, Schaffer, Ayal, Levitt, Anthony·2010·The Canadian Journal of Psychiatry

DOI 10.1177/070674371005500303

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Abstract

Objective The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is the largest open-label, pragmatic trial that has been undertaken to examine the treatment of major depressive disorder. At a cost of US$35 million over 6 years, STAR*D sought to test the effectiveness both of pharmacotherapy and of cognitive therapy, and to ascertain whether certain treatments are more optimal after one or more failed trials. Method Patients (n = 2876) who presented to either a psychiatry or family practice setting seeking treatment for depression were included in the STAR*D analysis. In the 4 levels of STAR*D, patients were randomized to various treatment monotherapies, combinations, or augmentation strategies. The primary outcome was remission, based on the Hamilton Depression Rating Scale. Secondary outcomes were response, as measured by clinician and patient self-report as well as various measures of patients' level of function and (or) quality of life. Results Remission rates for treatment levels 1 to 2 and 3 to 4 were 18% to 30% and 7% to 25%, respectively. There was no difference in effectiveness between any treatments at any treatment level. Patients with longer index episodes, more concurrent psychiatric or general medical disorders, and (or) lower measures of baseline function were less likely to achieve remission. There were no major differences between outcomes in patients treated in primary, compared with specialist care, nor were there significant differences…

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Authors: Sinyor, M., Schaffer, A., & Levitt, A.
Affiliations: University of Toronto (CA)
Sunnybrook Health Science Centre (CA)
Corresponding author: Schaffer, Ayal
ORCID: Sinyor, Mark
Schaffer, Ayal
Levitt, Anthony
Venue: The Canadian Journal of Psychiatry
Publisher: SAGE Publications
Published: 2010-03
Volume: 55
Issue: 3
Pages: 126-135
ISSN: 0706-7437 (ISSN-L)
1497-0015
DOI: 10.1177/070674371005500303
OpenAlex: W496281
Cited by: 396
References: 9
Citations by year: 2026: 18 · 2025: 23 · 2024: 37 · 2023: 58 · 2022: 38 · 2021: 46 · 2020: 34 · 2019: 25 · 2018: 21 · 2017: 18 · 2016: 14 · 2015: 9 · 2014: 11 · 2013: 11 · 2012: 14
FWCI: 1.59
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: The Canadian Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: Sanofi
AstraZeneca Canada
Servier
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, STAR*D trial, antidepressant treatment, cognitive therapy, treatment-resistant depression, treatment sequencing, remission, treatment response, augmentation strategies, primary care versus specialist care, quality of life, functional outcome
MeSH terms: Adult, Aged, Antidepressive Agents, Clinical Trials as Topic, Combined Modality Therapy, Depressive Disorder, Drug Administration Schedule, Drug Therapy, Combination, Humans, Middle Aged, Primary Health Care, Psychiatric Status Rating Scales, Quality of Life, Recurrence, Remission Induction, Research Design, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult

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The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: A Review

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