Acceptability of second-step treatments to depressed outpatients

A STAR*D report

Stephen R. Wisniewski, Maurizio Fava, Madhukar H. Trivedi, Michael E. Thase, Diane Warden, George Niederehe, Edward S. Friedman, Melanie M. Biggs, Harold A. Sackeim, Kathy Shores-Wilson, Patrick J. McGrath, Philip W. Lavori, Sachiko Miyahara, A. John Rush

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Objective: Treatment of major depressive disorder typically entails implementing treatments in a stepwise fashion until a satisfactory outcome is achieved. This study sought to identify factors that affect patients' willingness to accept different second-step treatment approaches. Method: Participants in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial who had unsatisfactory outcomes after initial treatment with citalopram were eligible for a randomized second-step treatment trial. An equipoise-stratified design allowed participants to exclude or include specific treatment strategies. Analyses were conducted to identify factors associated with the acceptability of the following second-step treatments: cognitive therapy versus no cognitive therapy, any switch strategy versus any augmentation strategy (including cognitive therapy), and a medication switch strategy only versus a medication augmentation strategy only. Results: Of the 1,439 participants who entered second-step treatment, 1% accepted all treatment strategies, 3% accepted only cognitive therapy, and 26% accepted cognitive therapy (thus, 71% did not accept cognitive therapy). Those with higher educational levels or a family history of a mood disorder were more likely to accept cognitive therapy. Participants in primary care settings and those who experienced a greater side effect burden or a lower reduction in symptom severity with citalopram were more likely to accept a switch strategy as compared with an augmentation strategy. Those with concurrent drug abuse and recurrent major depressive disorder were less likely to accept a switch strategy. Conclusions: Few participants accepted all treatments. Acceptance of cognitive therapy was primarily associated with sociodemographic characteristics, while acceptance of a treatment switch was associated with the results of the initial treatment.

Original languageEnglish (US)
Pages (from-to)753-760
Number of pages8
JournalAmerican Journal of Psychiatry
Volume164
Issue number5
DOIs
StatePublished - May 2007

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Outpatients
Cognitive Therapy
Depression
Therapeutics
Citalopram
Major Depressive Disorder
Mood Disorders
Substance-Related Disorders
Primary Health Care

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Wisniewski, S. R., Fava, M., Trivedi, M. H., Thase, M. E., Warden, D., Niederehe, G., ... Rush, A. J. (2007). Acceptability of second-step treatments to depressed outpatients: A STAR*D report. American Journal of Psychiatry, 164(5), 753-760. https://doi.org/10.1176/appi.ajp.164.5.753

Acceptability of second-step treatments to depressed outpatients : A STAR*D report. / Wisniewski, Stephen R.; Fava, Maurizio; Trivedi, Madhukar H.; Thase, Michael E.; Warden, Diane; Niederehe, George; Friedman, Edward S.; Biggs, Melanie M.; Sackeim, Harold A.; Shores-Wilson, Kathy; McGrath, Patrick J.; Lavori, Philip W.; Miyahara, Sachiko; Rush, A. John.

In: American Journal of Psychiatry, Vol. 164, No. 5, 05.2007, p. 753-760.

Research output: Contribution to journalArticle

Wisniewski, SR, Fava, M, Trivedi, MH, Thase, ME, Warden, D, Niederehe, G, Friedman, ES, Biggs, MM, Sackeim, HA, Shores-Wilson, K, McGrath, PJ, Lavori, PW, Miyahara, S & Rush, AJ 2007, 'Acceptability of second-step treatments to depressed outpatients: A STAR*D report', American Journal of Psychiatry, vol. 164, no. 5, pp. 753-760. https://doi.org/10.1176/appi.ajp.164.5.753
Wisniewski, Stephen R. ; Fava, Maurizio ; Trivedi, Madhukar H. ; Thase, Michael E. ; Warden, Diane ; Niederehe, George ; Friedman, Edward S. ; Biggs, Melanie M. ; Sackeim, Harold A. ; Shores-Wilson, Kathy ; McGrath, Patrick J. ; Lavori, Philip W. ; Miyahara, Sachiko ; Rush, A. John. / Acceptability of second-step treatments to depressed outpatients : A STAR*D report. In: American Journal of Psychiatry. 2007 ; Vol. 164, No. 5. pp. 753-760.
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