How effective is TMS?
Treatment as usual: the STAR*D trial
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) was a collaborative study on the treatment of depression, funded by the National Institute of Mental Health. Its main focus was on the treatment of depression in patients where the first prescribed antidepressant proved inadequate. A key feature of the study was its aim to be more generalizable to real clinical situations; this was done through the use of minimal exclusion criteria, incorporating patient preference, and not blinding the treatments (i.e. the patient and clinician both knew what treatment the patient was receiving). No monies were given by pharmaceutical companies although medication samples were provided for free. The study included 4,041 outpatients with nonpsychotic depression at 23 psychiatric and 18 primary care sites.The trial was completed in 2006, and data from it have been available since 2008.
The trial involved four different treatment levels, and patients were encouraged to enter the next level of treatment if they failed to achieve remission or response (50% reduction in symptoms) after a specified number of weeks.
As you can see, the best remission rate is for the first drug citalopram at 39%. From there, the rates go down until you reach the final Level 4 and see only a 15-16% remission rate. Considering that our average patient has gone through over 8 antidepressant trials and is moderately severely depressed, any higher remission rate would be an improvement. In addition, only 105 demoralized patients remained in the study out of the initial 3,671 who entered the medication trials.
For a more thorough "deep dive" with references, click the book to go the Treatment-Resistant Depression section under Doctors.
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