Achieving remission from depression: Who are the best candidates?

Each year, approximately 19 million Americans struggle with depression. Despite the availability of numerous antidepressant medications, the rates, timing, and baseline predictors of remission from depression in "real world" patients (as opposed to symptomatic volunteers recruited by advertising) have never been evaluated by a large clinical study.

Most clinical trials for depression have used response to measure success of treatment. A treatment response typically means that a patient's symptoms have decreased to a level of at least half of what they were initially. However, remission—the complete absence of symptoms—is a more stringent outcome measurement, and should, of course, be the aim of antidepressive treatments. However, clinically, we often fall short of achieving this goal.

In an effort to develop effective treatment guidelines for depression, the National Institute of Mental Health has conducted the largest and longest study ever undertaken to evaluate depression treatments: the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study.

The focus of STAR*D was to determine which treatments work best for outpatients (ages 18-75) with nonpsychotic major depressive disorder. Up to four levels of treatment were offered to patients based upon a measurement-based care approach. Measurement-based care routinely assessed patients' symptoms and side effects and relied upon a treatment manual (