Abstract

MARMOL FABREGA, Ana; INCHAUSPE AROSTEGUI, José Antonio; VALVERDE EIZAGUIRRE, Miguel Ángel  and  PIGOTT, Edmund. About the influential STAR*D study on clinical antidepressants: biases and outcomes. Rev. Asoc. Esp. Neuropsiq. [online]. 2018, vol.38, n.133, pp.217-238. ISSN 2340-2733.  https://dx.doi.org/10.4321/s0211-57352018000100012.

Randomized controlled trials (RCTs) show that antidepressants (ADs) in major depressive disorder (MDD) are only slightly superior to placebo. However, in practice, ADs are the main clinical resource, and switching and augmentation strategies are frequently used in case of failure of the first treatment attempt. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study was conducted to validate this practice. This study is the largest and the most influential about using ADs in real practice and is the object of this paper. The published STAR*D findings supported the prevailing model. They justified an aggressive use of ADs in doses and duration, step-by-step switching and augmentation strategies, a sequential treat-to-remission care, a measurement-based treatment applicable in Primary Care, and a long-term maintenance of those doses that were effective in the acute phase. The published STAR*D articles and data showed significant biases and inconsistent data. E. Pigott obtained the protocol and study data, confirming these biases. Actual results are similar to ordinary treatment. The total number of maintained remissions published at 12 months follow-up was 67%. Actual data indicates 2.7%. The main clinical guidelines continue to recommend the model of step-by-step treatments with ADs. Some of them propose adapting it according to the severity of MDD, preferring psychological therapies in the less severe cases, treatable in Primary Care. All of them maintain the STAR*D as the primary basis for real-world use of ADs.

Keywords : STAR*D; biases; outcomes; antidepressants; switching and augmentation strategies; clinical practice guidelines.

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