Talk:STAR-D

NEJM publication

Published earlier in the same year, it highlights the second step.[1] Would be reasonable to try to pull into the major points section and also to look at the letters/editorial.

tim's original description

Participants progressed through 4 different levels of treatment through 4 or 5 steps (depending on if they underwent CBT as a component of level 2).

Treatment by levels

Level 1

Citalopram (n=3,671)

Level 2

Patients could decline randomization to any of the following

Switch therapy:

Bupropion SR (n=239)

Sertraline (n=238)

Venlafaxine XR (n=250)

Augmentation therapy:

Citalopram + bupropion SR (n=279)

Citalopram + buspirone (n=286)

CBT + citalopram (n=85)

CBT therapy:

Referred to as CBT in levels 2A, 3, and 4

CBT alone (n=61)

CBT + citalopram (n=85)

Level 2A

Only those from CBT

Bupriopion SR (n=15)

Venlafaxine SR (n=16)

Level 3

Patients could decline randomization to any of the following

Switch therapy:

Nortriptyline (n=116, prior CBT n=5)

Mirtazapine (n=110, prior CBT n=4)

Augmentation therapy:

Addition of lithium (n=63, prior CBT n=6)

Addition of T₃ (n=70, prior CBT n=3)

Level 4

Tranylcypromine (n=55, prior CBT n=3)

Venlafaxine XR + mirtazapine (n=50, prior CBT n=1)

Treatment by steps

Step 1 (n=3,671)

Citalopram

Step 2 (n=1,439)

Switch therapy:

Bupropion SR (n=239)

CBT (n=62)

Sertraline (n=238)

Venlafaxine XR (n=250)

Augmentation therapy:

Bupropion (n=279)

Buspirone (n=286)

CBT (n=85)

Step 3 (n=390)

Level 2A, treated with prior CBT:

Bupropion (n=15)

Venlafaxine XR (n=16)

Level 3:

Switch therapy:

Mirtazapine (n=110)

Nortriptyline (n=116)

Augmentation therapy:

Lithium (n=63; plus bupropion n=8, plus citalopram n=37, plus sertraline n=10, plus venlafaxine XR n=15)

T₃ (n=70; plus bupropion SR n=8, plus citalopram n=37, plus sertraline n=10, plus venlafaxine XR n=15)

Step 4 (n=123)

Level 3 (n=18; see details above)

Tranylcypromine (n=55)

Venlafaxine XR/mirtazapine (n=50)