Posted by Phoenix1 on January 4, 2008, at 18:54:15
In reply to Re: STAR*D confirmed what patients already knew » LostBoyinNCBecksDark, posted by SLS on January 4, 2008, at 18:17:22
> > STAR*D has been one of the few decent studies psychiatry has conducted. STAR*D proved that SSRIs (Celexa) only work one third of the time...
> This study proves that, using the limited algorithm chosen, 70% of people can be brought to full remission. Can you imagine how many permutations of drug combinations can be offered if a 100% success rate was the goal? Maybe someone can produce a factorial using all the drugs found on my Psychiatric Drugs Chart. I have yet to add a few more.
> In my opinion, the STAR*D is close to being an irrelevant study if you want to know how many people can be brought to full remission employing unrestricted algorithms using the entire psychotropic arsenal.
> From the STAR*D review:
> "• For patients who present with major
> depressive disorder, STAR*D suggests that
> with persistence and aggressive yet feasible
> care, there is hope: after one round, approximately
> 30% will have a remission; after two
> rounds, 50%; after three rounds, 60%; and
> after four rounds, 70%."
> A 70% success rate is far from being "poor".
> Do you suppose the success rate would be more than 70% if any and all drugs and drug combinations were used?
> The STAR*D study has weaknesses that some people seem to feel argues in favor of a demonstration of poor efficacy. On the contrary, this study proves that the efficacy rate using a handful of drugs is 70%. That stands as a fair prognosis for an individual stricken with Major Depressive Disorder. I believe that the true rate of remission must be higher when there are no restrictions on the treatments available.
> As an aside, the NIH stands for "The National Institutes of Health". Notice the use of the plural form of the word "institutes". Each categorization of illness is formally assigned to and named an institute. The NIH is comprised of many individual institutes. There is no arbitrary dichotomy of mind versus body.
> - Scott
I agree on most points. But that 30% remission on ARM 1 is meaningful, because that is the standard of care when you go to most GP's for depression. Instead of augmenting or moving to something different, most GP's will just prescribe a second SSRI after the initial treatment failure. I think STAR*D provides the framework for a valuable algorithm for GP's to follow instead of blindly prescribing SSRI after SSRI without improvement like some GP's do. It's not perfect, but the data is valuable.