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With federally funded “big science” studies, evidence-based psychiatry is coming of age in a manner analogous to other medical specialties with studies of diabetes mellitus, hypertension, coronary heart disease, and cancer. One of the largest and best-known psychiatric studies is the multisite Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, which concerns the treatment of real-world patients with major depression, including many with comorbidities. Key results of this four-wave study have appeared in major journals (see Journal Watch Psychiatry Apr 5 2006; Jul 17 2006; Oct 16 2006).
The acute treatment protocol, which initially enrolled more than 4000 patients, mimicked what many clinicians do sequentially in practice.…