ArticlemedRxiv : the preprint server for health sciences2025
Restoring STAR*D: A Reanalysis of Drug-Switch Therapy After Failed SSRI Treatment Using Patient-Level Data with Fidelity to the Original STAR*D Research Protocol.
Article in medRxiv : the preprint server for health sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
Funding
Abstract
Background: The Methods: We reanalyzed the patient-level dataset of STAR*D's drug-switch treatment therapies- Results: While our reanalysis largely comported with STAR*D's published findings of no significant differences between drug-switch treatments, we found the following discrepancies: Lower than reported step-2 remission rates ranging from 16.2 to 19.3% (versus 17.6 to 24.8%); A significant increase in treatment-emergent suicidal ideation during the step-2 drug-switch therapies ranging from 11.2 to 15.0% compared to step-1 citalopram treatment (9.0%); A four times greater number of severe suicidal behaviors reported by the treating clinicians compared to the published suicide-related Serious Adverse Events (16 versus 4); and A sustained remission rate of only 3.1 to 8.4%. Conclusion: Compared to the original publication, our reanalysis found lower remission rates and more suicidal risk than reported. This adds to the discrepancies found in our prior reanalysis and also to the finding that switching antidepressants is not well supported by the evidence.
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