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An interesting piece posted on Slate.com yesterday called attention to the results of a NIMH study that might help rank existing antidepressant medications in order of effectiveness.

The study, which goes by the awkward moniker of STAR*D (Sequenced Treatment Alternatives to Relieve Depression), focused "on the common clinical question of what to do next when patients fail to respond to a standard trial of treatment with an antidepressant medication," according to the study's website. The study, the website continues, aimed "at defining which subsequent treatment strategies, in what order or sequence, and in what combination(s) are both acceptable to patients and provide the best clinical results with the least side effects."

STAR*D began in 2001 with a sample of 3,000 depressed patients. The patients were started on Celexa, and those who didn't experience full remission of symptoms on Celexa alone were moved on to other treatments or had their Celexa regimes augmented with additional agents.

Papers on the prelimiary results have appeared recently in the Journal of Psychiatric Research (Issue 40, pages 59-69), and the New England Journal of Medicine (Issue 356, pages 1231-1242 and 1243-1252).

You can also access the NIMH's March 23 press release about the study, with links to a number of STAR*D-related pages, here.

The author of the Slate article, Sarah E. Richards, argues that the STAR*D study "underscores the need for more comparative data--not just for mental-health drugs, but in all areas of health care."

Comparative studies of drug effectiveness, she says, are often nonexistent or difficult to come by, since drug companies are not required to prove to the FDA that a proposed new product is more effective than a product already on the market.

Dr John Grohol, a psych blogger, offers a counterpoint to the mainstream press's breathless enthusiasm about the STAR*D results, here.