Rush AJ, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps¶

One-paragraph summary¶

STAR*D enrolled 3,671 step-1 outpatients into measurement-based sequenced treatment. QIDS-SR remission fell from 36.8% at step 1 to 30.6%, 13.7%, and 13.0% at later steps; the report calculated theoretical cumulative remission of 67%, while relapse increased with number of steps.

Key findings¶

Successive treatment steps yielded diminishing remission.
Later-step remitters relapsed more often.
Attrition complicates cumulative interpretation.

Limitations¶

Open-label effectiveness design; limited randomized comparisons.
Multiple outcomes and denominators; cumulative estimate is contested.

Why it matters¶

STAR*D became the dominant empirical narrative for sequential antidepressant care and the claim that persistence produces cumulative remission.

Cited by wiki pages¶

Overview
The efficacy debate
Treatment-resistant depression