Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice

• DOI: 10.1176/appi.ajp.163.1.28
• Publication Date: 2006-01-03T17:03:00Z
• Authors: Madhukar H. Trivedi; A. John Rush; Stephen R. Wisnie...; Andrew A. Nierenberg; Diane Warden; Louise Ritz; Grayson Norquist; Robert H. Howland; Barry Lebowitz; Patrick J. McGrath; Kathy Shores-Wilson; Melanie M. Biggs; G. K. Balasubramani; Maurizio Fava
• Keywords: Citalopram; Depression; Major depressive episode; Serotonin reuptake inhibitor; Clinical Practice

Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression, but the rates, timing, and baseline predictors of remission in "real world" patients not established. The authors' primary objectives this study were evaluate effectiveness citalopram, an SSRI, using measurement-based care actual practice, identify symptom outpatients with major depressive disorder.This clinical included disorder who treated 23 psychiatric 18 settings. received flexible doses citalopram prescribed by clinicians for up 14 weeks. assisted a research coordinator application care, which routine measurement symptoms side effects at each treatment visit use manual that described when how modify medication based on these measures. Remission was defined as exit score <or=7 17-item Hamilton Depression Rating Scale (HAM-D) (primary outcome) or <or=5 16-item Quick Inventory Depressive Symptomatology, Self-Report (QIDS-SR) (secondary outcome). Response reduction >or=50% QIDS-SR score.Nearly 80% 2,876 analyzed sample had chronic recurrent depression; most also number comorbid general medical conditions. mean dose 41.8 mg/day. rates 28% 33% (QIDS-SR). response rate 47% Patients settings did differ rates. A substantial portion participants achieved either so after 8 weeks treatment. Participants Caucasian, female, employed, higher levels education income HAM-D rates; longer index episodes, more concurrent disorders (especially anxiety drug abuse), disorders, lower function quality life associated rates.The highly generalizable axis I III comorbidity closely resemble those seen 8-week efficacy trials. systematic easily implemented procedures may have achieving results.