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Home » How to Bring STAR*D Techniques into Your Practice

How to Bring STAR*D Techniques into Your Practice

May 1, 2006
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue

Because the first results from STAR*D make antidepressants look less powerful than we might have hoped, researchers have emphasized another aspect of the study – namely, that it represents a system that allows us to bring research techniques into our practices. And while some statements made in support of the STAR*D methodology come across as pretty grandiose – for example, “This measurement-based care approach represents a paradigm shift to the use of easily employed research tools in clinical practice” (Am J Psychiatry 2006;163:28-40, p 35) – in fact, a review of the STAR*D treatment manual is a useful exercise.

The idea behind the STAR*D protocol is that you score the patient at every visit, and, based on the score, you decide whether or not to increase the dose. Granted, this is what we all try to do daily, but in the course of a busy clinical practice we may not always be as careful and systematic as we’d like. One of the two depression scales used in STAR*D, the QIDS (Quick Inventory of Depressive Symptomatology) is a scale that you can use in your office to ensure that your follow-up depression evaluations are systematic. It is available free of charge from the STAR*D website (www.star-d.org, “clinician resources/assessment tools”). It comes in two versions, a clinician report and a patient self-report.

STAR*D researchers used the results of both QIDS scales to make dosing decisions according to a specific dosing protocol. At each decision point, researchers increased the dose if patients were not in remission; otherwise, the dose remained the same. This protocol, also available on the study’s website, is nice to have as a reference in your office. These guidelines are pretty aggressive, but not unreasonable, and will serve to encourage you to get those doses up to a good level.
STAR*D Monotherapy Dosing Guidelines


Celexa



Effexor XR



Wellbutrin SR (split BID)



Zoloft



Day 1:
20 mg QD



Day 1:
37.5 mg QD



Day 1:
150 mg QD



Day 1:
50 mg QD



Day 28:
40 mg QD



Day 8:
75 mg QD



Day 8:
200 mg QD



Day 14:
100 mg QD



Day 42:
60 mg QD



Day 15:
1 50 mg QD



Day 28:
300 mg QD



Day 28:
150 mg QD



Day 28:
225 mg QD



Day 42:
400 mg QD



Day 63:
200 mg QD



Day 42:
300 mg QD



Day 63:
375 mg QD




 
STAR*D Augmentation Dosing Guidelines (All doses split BID)


BuSpar



Wellbutrin SR



Day 1: 15 mg QD



Day 1: 200 mg QD



Day 8: 30 mg



Day 28: 300 mg



Day 28: 45 mg



Day 42: 400 mg



Day 42: 60 mg



General Psychiatry
KEYWORDS antidepressants practice-tools-and-tips
    www.thecarlatreport.com
    Issue Date: May 1, 2006
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    Table Of Contents
    The STAR*D Trial: First Results
    How to Bring STAR*D Techniques into Your Practice
    Interpreting the STAR*D Trial
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