Quantitative assessment vital in depression management.(Clinical Rounds)

Routine, quantitative measurement of depression symptoms and treatment side effects at every clinical visit may help physicians to determine when to change their prescribing patterns for treating depression, findings from the STAR*D study suggest.

The results of STAR*D (Sequenced Treatment Alternatives to Relieve Depression), the largest trial of treating major depression in real-world psychiatric or primary care settings, "underscore the importance of tailoring treatment to the individual patient, monitoring the effects of treatment, and adjusting medications when necessary, as is common practice when prescribing medications for any other medical illness," Dr. Darrel A. Regier, director of research for the American Psychiatric Association, said in an interview.

The STAR*D study included 2,876 patients in 18 primary care and 23 psychiatric settings who would have been excluded from most efficacy trials--those who are seeking help and have chronic or recurrent depression, substance abuse, or psychiatric and medical comorbidities.

About 80% of the patients in the study had at least one of those conditions (Am. J. Psychiatry 2006;163:28-40).

In the first round of the study, in which all patients received treatment with citalopram (Celexa), about 30% of patients achieved remission while 47% had a response after an optimal treatment based on the dose and duration of treatment, reported Dr. Madhukar H. Trivedi of the University of Texas Southwestern Medical Center at Dallas and his associates. The investigators defined remission as an exit score of 5 or less on the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) or an exit score of 7 or less on the 17-item Hamilton Depression Rating Scale (HAM-D) and response as 50% or greater improvement in QIDS-SR score.

The results were similar in the primary care and psychiatric settings.

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