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Alternatives similar for depression treatment failures* Clinical Question What is the best remedy for patients who do not rejoin to a selective serotonin reuptake inhibitor? * Bottom Line Bupropion SR (Wellbutrin), sertraline (Zoloft) and venlafaxine XR (Effexor) are equally effective at inducing remission or answer in patients with persistent symptoms of depression despite initial treatment with citalopram (Celexa). greatest in quantity patients will not go into remission, notwithstanding that and this study lacked a placebo direction group. (LOE: 1b) application of mind Design Randomized controll trial (nonblinded) Funding Government Allocation Uncertain Setting Outpatient (any) Synopsis The Sequenc Treatment Alternatives to Relieve Depression (STAR * D) trial was a mingled study that began by treating 2876 press downed patients given citalopram in an average dose of 40 mg/d Approximately individual third of patients went into remission (no symptoms) and approximately half showed a replication (at least a 50% reduction in symptoms). Those who did not answer (n=1439) were invited to list in the second phase of the trial, reported here. Treatment options for patients who failed the initial course of citalopram included switching physics (out of class to bupropion SR within class to sertraline, or to the "dual-action" agent venlafaxine XR) switching to cognitive therapy, or augmenting by means of adding bupropion SR, buspirone, or cognitive therapy. Maximal doses were 400 mg daily for bupropion SR 200 mg daily for sertraline, and 375 mg daily for venlafaxine XR Patients could opt without of certain treatment options; for example, they could limit their randomization to single augmentation options or only switch options. sole 21 patients agreed to randomization to any of the 7 treatment options. The 3 different switch option collections had between 238 and 250 patients and they were followed up for up to 14 weeks. Their average age was 42 years, 59% were women and 18% were African American. greatest in quantity had recurrent depression with a mean of 7 previous episodes. Within the switch options, the answer and remission rates as measured by dint of the Hamilton Rating Scale for Depression (HRSD) and the Quick Inventory of Depressive Symptomatology were similar (HRSD remission rates of 21% for bupropion SR 18% for sertraline, and 25% for venlafaxine XR) Adverse consequences were generally similar between groups A major limitation of this inquiry was the absence of a placebo dominion government group. Given the relapsing, remitting nature of depression it is likely that more [i]or[/i] less patients would have gone into remission without any therapy at all. Not enough patients chose to be randomized to the one and the other switch and augmentation options to allow us to compare them. FAST TRACK Given the nature of depression it is likely more [i]or[/i] less patients would have gone into remission without any therapy at all Rush AJ, Trivedi MH Wisniewski SR et al, for the STAR*D application of mind Team. 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