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The NIH-sponsored Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study is designed to mimic a “real-world” approach to treating depression. Outpatients with major depression were treated with the selective serotonin reuptake inhibitor (SSRI) citalopram (Celexa) in 23 psychiatric and 18 primary-care sites (level 1). Patients who did not achieve remission or who developed drug side effects then participated in randomized trials of alternative treatments (level 2).
In the level-1 study, 2876 patients (mean age, 41), most of whom had a long history of depression, received citalopram according to a study protocol for up to 14 weeks. The rate of remission was 28% based on the Hamilton Rating Scale for Depression.
In a level-2 study…