June 16, 2008 UT Southwestern Medical Center psychiatry researchers have taken what they learned from their groundbreaking research on treating depression and are applying it to real-world clinical settings.
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study was the largest ever on the treatment of major depressive disorder and is considered a benchmark in the field of depression research. The six-year, $33 million study initially included more than 4,000 patients from clinics across the country.
STAR*D provided evidence for step-by-step guidelines to address treatment-resistant depression and found that half of depressed patients became symptom-free or had major improvement after the first two treatments with medication.
Based on those findings, Dr. Madhukar Trivedi, professor of psychiatry at UT Southwestern and a leader of the STAR*D study, developed a computerized treatment system and is now testing it in a Nashville, Tenn.-based mental and behavioral health care organization.
"This is exciting because although this project incorporates elements of STAR*D and cutting-edge algorithms developed and refined by UT Southwestern researchers over decades, it moves way beyond that," said Dr. Trivedi.
The computer software provides a step-by-step guide to assist doctors as they're treating patients. For example, the program prompts physicians with more specific questions that go beyond "Do you feel better?" after taking medication.
"This computerized system gives doctors assistance at the time that they are seeing the patient," Dr. Trivedi said. "It's like walking with someone learning to ride a bike versus just sitting there and telling them how to ride."
The administration of depression treatment is often inadequate, Dr. Trivedi said.
"Major depressive disorder treatment lags behind the care of other chronic diseases," said Dr. Trivedi. "It's not like an infection where you treat for a short time and that's it."
Doctors often don't ask follow-up questions of their patients, and they certainly do not routinely use systematic measurement tools to gauge progress, he said.
"My interest is in helping clinicians, researchers and patients in real-practice settings," Dr. Trivedi said. "It's a different magnitude of complexity when you go to a busy clinical practice setting away from academic centers."
In the STAR*D project, also led by Dr. A. John Rush, professor of clinical sciences and psychiatry at UT Southwestern, only about 50 depression patients from each test-site clinic were selected to participate.
"Studying depression in a very small setting with an isolated patient population was important as we sought to answer certain essential questions, but it is different from the regular practice of doctors and patients," Dr. Trivedi said.
In the current research project, all patients with depression at study sites will be included. The number of patients could reach 8,000, depending on how many are scheduled for treatment with Centerstone, a nonprofit provider of community-based behavioral health services that has partnered with Dr. Trivedi. Centerstone operates facilities in middle Tennessee and southern Indiana.
"Previous research has pulled out a few drops of water from a pond, whereas now we are looking at the whole pond and all its possible murkiness," Dr. Trivedi said. Centerstone facilities were chosen in part because of their cohesiveness and technological capabilities.
"We know depression is similar to other chronic illnesses and yet treatable. We know we have a lot of options," Dr. Trivedi said. "While we are still developing other treatment alternatives, it's important to make sure that the research we have now works in the real world. This work with Centerstone will help ensure that depressed patients receive the most effective treatment regime available."
The work is funded by a $1.2 million grant over three years awarded by the Agency for Health Care Research Quality for an information technology initiative.
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