Major depressive disorder is a common disorder that affects 5% to 13% of medical outpatients. The treatment of depression can be challenging, with many first-line options and even more second-line or next-step options. The STAR*D trial was the first of its kind developed to evaluate clinical strategies to improve outcomes for patients with treatment-resistant depression and determining the best next-step treatment option for patients who did not respond adequately to earlier treatment attempts. The trial included a widely representative group of outpatients so as to be applicable to the current practice in the treatment of depression. The trial consisted of 4 different treatment strategies with both switching and augmentation options. Patients were permitted to select treatment options at each of the levels that they themselves selected, creating a “realworld” setting in the trial. Patients were recommended to continue through each level until remission was reached. The study, though limited in size at each level, has provided much-needed information for the continued treatment of major depressive disorder.
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