Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.
In Level 1 of STAR*D (Sequenced Treatment Alternatives to Relieve Depression), patients with major depressive disorder were all given citalopram to assess remission and response rates, treatment durations, and pretreatment features associated with remission (the virtual absence of symptoms). Remission rates were around 30%, and often required at least 8 weeks of citalopram. Higher remission rates were seen in patients who were caucasian, female, employed, more educated, and with fewer psychiatric comorbidities.
- N=2,876, ages 18-75, with nonpsychotic major depressive disorder, determined by a score ≥14 on Hamilton Depression Rating Scale (HAM-D), all receiving citalopram (open label), with no placebo control, for up to 14 weeks.
- Setting: clinical sites across the United States providing primary (n=18) or psychiatric (n=23) care.
- Primary outcome: remission, defined as score ≤7 on Hamilton Depression Rating Scale (HAM-D)
- Secondary outcome: remission, defined as score ≤5 on Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR). Response defined as reduction of ≥50% in baseline QIDS-SR score.
- Remission rates at end of study were 27% (HAM-D) and 33% (QIDS-SR).
- Response rate was 47% (QIDS-SR).
- At least 8 weeks of treatment were required to achieve remission in 40.3% of remitters, and response in 56% of responders.
- 4% of patients experienced at least one serious adverse effect, and 89% of these patients did not achieve HAM-D remission.
- Higher remission rates were associated with caucasian race, female gender, employment, higher levels of education or income.
- Lower remission rates were associated with more concurrent psychiatric disorders (especially anxiety and substance abuse), concurrent medical disorders, lower baseline function.
- Factors that were not significantly associated with remission included: family history or depression, history of suicide attempt, current age, age at onset
Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. AJP. 2006;163(1):28–40.