Posted by SLS on January 5, 2008, at 6:43:29
In reply to Re: STAR*D confirmed what patients already knew, posted by Cecilia on January 5, 2008, at 6:04:46
> The other thing I don't understand about the study is where they found these depressed people who hadn't already tried these very common drugs already. They certainly didn't include anybody with chronic depression or they would have already tried them. So they probably got much better results than in the "real world". Cecilia
"Entry criteria were broad and inclusive
Patients had to:
• Be between 18 and 75 years of age
• Have a nonpsychotic major depressive
disorder, identified by a clinician and confirmed
with a symptom checklist based on
the Diagnostic and Statistical Manual,
fourth edition revised,20 and for which
antidepressant treatment is recommended
• Score at least 14 on the 17-item Hamilton
Rating Scale for Depression (HAMD17)
21
• Not have a primary diagnosis of bipolar
disorder, obsessive-compulsive disorder, or
an eating disorder, which would require a
different treatment strategy, or a seizure
disorder (which would preclude bupropion
as a second-step treatment)."
The investigators made no other exclusions. Unless I missed it, and with my reading skills so impaired, this is entirely possible, there is no mention of excluding subjects whom were previously treated with psychotropic drugs. The subjects studied seems to be representative of the general population - the objective of the study.
"FEW DIFFERENCES BETWEEN
PSYCHIATRIC, PRIMARY CARE PATIENTS
The patients seen in primary care clinics were
surprisingly similar to those seen in psychiatric
clinics.27,28 The two groups did not differ in
severity of depression, distribution of severity
scores, the likelihood of presenting with any of
the nine core criteria of a major depressive
episode, or the likelihood of having a concomitant
axis I psychiatric disorder in addition
to depression (about half of participants
in each setting had an anxiety disorder).
Recurrent major depressive disorders were
common in both groups, though more so in
psychiatric patients (78% vs 69%, P < .001),
while chronic depression was more common
in primary care than in psychiatric patients
(30% vs 21%, P < .001). Having either a
chronic index episode (ie, lasting > 2 years) or
a recurrent major depressive disorder was common
in both groups (86% vs 83%, P = .0067).
That said, primary care patients were
older (44 years vs 39 years, P < .001), more of
them were Hispanic (18% vs 9%, P < .001),
and more of them had public insurance (23%
vs 9%, P < .001). Fewer of the primary care
patients had completed college (20% vs 28%,
P < .001), and the primary care patients tended
to have greater medical comorbidity.
Psychiatric patients were more likely to have
attempted suicide in the past and to have had
their first depressive illness before age 18"
From: "The STAR*D study: Treating depression in the real world"- Scott
poster:SLS
thread:804126
URL: http://www.dr-bob.org/babble/20080105/msgs/804392.html