What Are the Implications of the STAR*D Trial for Primary Care?
Notice bibliographique
Résumé
BACKGROUND: Although results of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial have been widely disseminated to mental health care providers, hitherto, primary care providers, who diagnose and manage most individuals with depressive syndromes, have had minimal exposure to the study's key findings. OBJECTIVE: We aim to provide translational implications of the STAR*D trial for primary care practitioners as well as for future research vistas. DATA SOURCES: A PubMed search was carried out with key search terms STAR*D and treatment-resistant depression found in articles published from 2001 through 2007. STUDY SELECTION: Articles reporting on the STAR*D outcomes at each sequence of treatment were the primary sources for review. DATA EXTRACTION: Results from the primary outcome measures at each sequential treatment were extracted and reviewed. Articles reporting variables affecting the probability of achieving remission were also selected. RESULTS: The STAR*D trial is the largest effectiveness study evaluating next-step therapies in real-world patients with major depressive disorder. The ecological validity of the study results are burnished by several methodological factors, including the enrollment of both publicly and privately insured patients, the recruitment of patients in primary and specialty care settings, the broad inclusion criteria, the use of pharmacologic and psychosocial (i.e., cognitive-behavioral therapy) treatment options, the use of measurement-based care, and the randomized clinical equipoise design. Taken together, remission rates of approximately 50% to 55% were reported after 2 sequential treatment interventions. A substantial percentage of individuals achieving remission do so after 6 weeks of treatment. The probabilities of achieving remission with third- and fourth-step therapy were considerably lower, i.e., ≤ 25%. The probabilities of relapse during continuation therapy increased as a function of number of treatment trials required to achieve remission. There is no evidence that individuals failing to achieve remission with a selective serotonin reuptake inhibitor (SSRI) have a greater probability of remitting with a separate class antidepressant versus an alternative SSRI. CONCLUSION: A window of therapeutic opportunity appears to exist insofar as acute remission rates in major depressive disorder are greatest with the first 2 sequential treatments. Taken together, measurement-based care affords the greatest probability that an individual will achieve remission. Despite optimal continuation treatment, relapse rates remain significant, underscoring the chronicity of depressive disorders.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».