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The STAR*D trial: the 300 lb gorilla is in the room, but does it block all the light?
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It cost US tax payers $35 million and the results were announced on the front page of the Washington Post—so what did the STAR*D trial tell us about how to help people presenting with depression? First the name, STAR*D stands for Sequenced Treatment Alternatives to Relieve Depression. The emphasis in STAR*D was that it was a series of pragmatic trials that as closely as possible replicated what was possible in usual clinical care. The trials are divided into four groups or levels, with each level consisting of several randomised controlled trials with the participants being people with depression who hadn’t responded to treatment at the previous level. The study is the largest series of randomised controlled trials ever done in psychiatry and the results are complicated and published in numerous papers in several different journals. There is however a website hosted by the funder which summarises most of the findings
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