McManamy Explains It All For You

I posted results from the latest round of the STAR*D trials yesterday, and then asked John McManamy, who has been tracking these issues religiously for a decade, what he thought. Here's his response:

"The third round STAR*D results are definitely major news. We clearly have to rethink antidepressant treatment strategy and we've got the study to prove it. If a patient has failed on two trials of antidepressants we're clearly looking at the falling over the edge of the cliff phenomenon where there is less than a one in five chance of success.

The AJP editorial was the usual blather, but the study findings were not. A lot of the study authors (maybe all of them) get very good money from the pharmaceuticals, yet they came out with what amounts to an anti-antidepressant study.

Until we get the breakthrough genetic and biological discoveries, we have to work with what we've got. This means being smarter with our current meds and talking therapies. That's what STAR*D was designed for. STAR*D should be publishing results soon on talking therapy.

The flaw in the STAR*D study is they probably didn't anticipate such dismal results in round three. There should have been an option to switch these patients onto bipolar meds to see what happens. Yes, I know you have you're skeptical, but we're not going to have any real answers unless we put this to the test.

The leading bipolar experts—Goodwin, Akiskal, Ghaemi, and others—are telling us that a lot of so-called unipolar depressions have characteristics of bipolar depressions. This suggests treating these people as if they had bipolar, with mood stabilizers. The catch is we're not very good at treating people with bipolar depressions. We have a long way to go."

I'll have more to say about STAR*D soon. And keep in mind that the main results from STEP-BD, a similar study on treating bipolar disorder, will be out in the fall. And so far they are looking as dismal as the STAR*D ones.