• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • 2MM Podcast
  • Write for us
  • Contact Us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home The Classics Psychiatry Classics

The STAR*D trials II: Switching antidepressants [Classics Series]

byAndrew Cheung, MD MBA
November 9, 2014
in Psychiatry Classics, The Classics
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. In cases where citalopram fails or cannot be tolerated, approximately 1 in 4 patients will experience remission of their depression symptoms by switching to sustained-release buproprion, sertraline, or extended-release venlafaxine.

Original Date of Publication: March 2006

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trials explored the management of patients who had refractory depression despite treatment with a selective serotonin-reuptake inhibitor (SSRI). Two papers were published based on data from the STAR*D trials in NEJM in 2006, which involved outpatients with nonpsychotic major depression who had not experienced remission with citalopram alone. In both papers, the primary outcome measure was remission with a score of <7 on the Hamilton Rating Scale for Depression (HRSD-17), while secondary outcome measurement of remission and response was done using the Quick Inventory of Depressive Symptomatology (QIDS-SR-16). Patients in this study were given the option to 1) augment their therapy by adding other agents or 2) switch to another therapy.

Study Rundown: In patients suffering from refractory depression after a trial of citalopram, switching to another medication resulted in approximately 1 in 4 patients experiencing remission of their symptoms with sustained-release buproprion, sertraline, or extended-release venlafaxine. A strength of the STAR*D studies is the few criteria for inclusion and exclusion, which suggests that these findings may be very generalizable to an outpatient population. Limitations include the lack of a placebo control group and the fact that treatment delivery was unblinded. Interestingly, the rates of remission with switching medications were lower than the remission rates observed with augmenting therapy. Part of this may be attributed to the differences in patient pools seen in the two studies (i.e., the “medication switch” study having a larger proportion of patients who could not tolerate citalopram) and the inadequate doses/treatment durations. Nevertheless, this study demonstrates clinically meaningful remission rates when switching to other antidepressants.

Click to read study in NEJM

In-Depth [randomized, controlled trial]: Apart from augmentation, switching to a different anti-depressant represents another option for managing patients who do not experience depression remission despite treatment with an SSRI. In this study, 727 outpatients with nonpsychotic depression were enrolled – all had been previously treated with citalopram and had not experienced remission or could not tolerate citalopram. Patients were randomized to switch from citalopram to 1) sustained-release buproprion (a norepinephrine-dopamine reuptake inhibitor, NDRI), 2) sertraline (another SSRI), or 3) extended-release venlafaxine (a serotonin-norepinephrine reuptake inhibitor, SNRI).

RELATED REPORTS

Early screening for emotional and cognitive issues may improve psychiatric outcomes for stroke patients

Calorie restriction and low-fat diets may reduce depression in individuals with higher cardiometabolic risk

Glucagon-like peptide-1 receptor agonists associated with lower depression risk in older adults with diabetes

Remission rates were not significantly different between the three treatment groups, as measured by HSRD-17 scores (21.3% in the buproprion group, 17.6% in the sertraline group, 28.4% in the venlafaxine group). Moreover, the three groups were not significantly different with regards to response/remission rates, or time to response/remission, as measured by QIDS-SR-16 scores, nor were they significantly different in terms of their rates of side effects or serious adverse events.

Image: PD

©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT.

Tags: buproprioncitalopramdepressionserotoninsertralineSSRISTAR*D
Previous Post

Reducing surgical complications may increase costs

Next Post

Lifestyle modifications vary based on socioeconomic status in cardiovascular patients (PURE Study)

RelatedReports

Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults
Neurology

Early screening for emotional and cognitive issues may improve psychiatric outcomes for stroke patients

June 20, 2025
Vegetarian diet may lower incidence of colorectal cancer
Psychiatry

Calorie restriction and low-fat diets may reduce depression in individuals with higher cardiometabolic risk

May 20, 2025
Poor olfaction linked to increased mortality in older adults
Endocrinology

Glucagon-like peptide-1 receptor agonists associated with lower depression risk in older adults with diabetes

February 24, 2025
Quick Take: Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse
Chronic Disease

Interruptive clinical decision supports may be more sensitive for suicide screening

January 8, 2025
Next Post
Lifestyle modifications vary based on socioeconomic status in cardiovascular patients (PURE Study)

Lifestyle modifications vary based on socioeconomic status in cardiovascular patients (PURE Study)

Glutamine and antioxidant supplementation provide no benefit for critically-ill patients

Glutamine and antioxidant supplementation provide no benefit for critically-ill patients

Increased inflammatory markers found in nonsurviving pediatric burn patients

Increased inflammatory markers found in nonsurviving pediatric burn patients

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Nerandomilast slows decline in FVC in idiopathic pulmonary fibrosis
  • Mazdutide significantly reduces weight in adults with overweight or obesity
  • Oral vancomycin may be effective for pouchitis in inflammatory bowel disease
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
No Result
View All Result

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.