Antidepressant monotherapy

The prospective STAR*D study examined the effectiveness of antidepressants in a naturalistic population of outpatients with MDD seeking medical care:²

• All participants (n=3,671) received an SSRI as their first-line treatment, and one third of these patients achieved remission.
• Patients who failed to respond to the SSRI were randomly assigned^a to one of seven possible second-line treatments. Of the 727 patients who received second-line pharmacotherapy, a quarter achieved remission.
• Patients who failed on any of the seven possible second-line treatments were randomly assigned^a to one of four possible third-line treatments. Of the 226 patients who received third-line monotherapy, only 11% achieved remission.

^aTo mimic clinical practice, patients were allowed to choose the second-line treatment strategy to which they were willing to be randomized.

References:

1.Lam RW, Kennedy SH, Adams C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 update on clinical guidelines for management of major depressive disorder in adults: Réseau canadien pour les traitements de l’humeur et de l’anxiété (CANMAT) 2023: mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Can J Psychiatry 2024; 69 (9): 641–687.

2.Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006; 163 (11): 1905–1917.