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首页> 外文期刊>The journal of clinical psychiatry >Sequenced Treatment Alternatives to Relieve Depression (STAR*D): lessons learned.
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Sequenced Treatment Alternatives to Relieve Depression (STAR*D): lessons learned.

机译：缓解抑郁症的有序治疗选择（STAR * D）：经验教训。

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Sequenced Treatment Alternatives to Relieve Depression (STAR*D), the largest prospective, randomized antidepressant treatment trial to date in outpatients with major depressive disorder (MDD) recruited from real-world clinical settings, enrolling 4011 outpatients aged 18 to 75 years with nonpsychotic MDD. Designed to determine which treatments are most effective after nonremission or intolerance to an initial selective serotonin reuptake inhibitor (SSRI), or to any of a series of subsequent randomized treatments, STAR*D was conducted in 18 primary and 23 psychiatric care settings across the United States. This review summarizes unique features of the study, initial remission rates and associated par-ticipantcharacteristics, remission rates for subsequent treatment steps, relapse rates during follow-up, and clinical implications.STARD has several features that make it unique. (1) The study enrolled treatment-seeking patients (as opposed to symptomatic volunteers) with nonpsychotic MDD confirmed with a DSM-IV checklist and a score of > 14 on the 17-item Hamilton Rating Scale for Depression (HAM-D). (2) To maximize generalizability, few exclusions were utilized. Thus, the study included patients with most concurrent psychiatric and general medical conditions, including those with active substance abuse or suicidality, as long as outpatient care was appropriate. (3) As in clinical practice, patients could accept or decline certain strategies as long as sufficient options for randomization remained. (4) Patients, clinicians, and raters always knew the medication and dose administered.
机译：从现实世界的临床环境中招募的重度抑郁症（MDD）门诊患者中迄今为止最大的前瞻性，随机抗抑郁治疗试验，用于缓解抑郁的有序治疗替代方案（STAR * D），招募了4011名18至75岁的非精神病性MDD门诊患者。 STAR * D旨在确定在不缓解或不耐受初始选择性5-羟色胺再摄取抑制剂（SSRI）或随后一系列随机治疗中的任何一种之后最有效的治疗方法，在全美18个主要和23个精神科医疗机构中进行了STAR * D状态。这篇综述总结了这项研究的独特特征，初始缓解率和相关的同病征特征，后续治疗步骤的缓解率，随访期间的复发率以及临床意义。STARD具有使其独特的几个特征。 （1）该研究招募了具有非精神病性MDD的寻求治疗的患者（相对于有症状的志愿者），这些患者经DSM-IV清单确认且在17个项的汉密尔顿抑郁量表（HAM-D）中得分大于14。 （2）为了最大程度地提高通用性，很少使用排除项。因此，只要门诊治疗适当，该研究就包括大多数同时患有精神病和一般医学疾病的患者，包括患有活性物质滥用或自杀的患者。 （3）在临床实践中，只要仍有足够的随机选择余地，患者就可以接受或拒绝某些策略。 （4）患者，临床医生和评估者始终知道所用的药物和剂量。

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