John McManamy has written a great piece on depression heterogeneity at healthcentral.com that nicely sums up our study “Depression is not a consistent syndrome: an investigation of unique symptom patterns in the STAR*D study” published in the Journal of Affective Disorders (PDF).
His main message:
The quick takeaway is that not all depressions are the same. Which is why – to freely editorialize – STAR*D was doomed from the get-go. Back in the early 2000s, it seemed like a good idea to treat 3,700 individuals with the same drug. A decade later, it is easy to see the absurdity in that proposition. Perhaps “depression” is one disease with numerous manifestations. But if that were the case, we would have a magic bullet for all seasons. At the least, we would expect better results from our antidepressants and talking therapies. More likely, we are looking at different illnesses that differ in cause and biology, and – by implication – treatment […]. To date, we have failed to identify reliable biomarkers for depression. Nor have we made credible attempts to differentiate one depression from another based on what we can observe and investigate. Until we do, we remain mired in ignorance. In the authors’ words, we need to acknowledge that major depression “is not one coherent condition with a single cause.” Amen.