Better
clinical outcome for major depression with
algorithm-guided treatment than treatment as
usual
Prevalence
of major depressive disorder is high and the
costs of its treatment are substantial due to
the chronicity or recurrence of this mental
illness. In spite of the availability of many
effective treatments, it is well known that
depression is under-recognized and under- or
mis-treated, leading to low rates of response or
remission. Recently guidelines or algorithms for
the application of pharmacotherapeutic options
for major depressive disorder have been defined.
The Texas Medication Algorithm Project compared
clinical outcomes for major depressive disorder
using algorithm-guided treatment (ALGO) with
treatment as usual (TAU).
This multisite (ALGO and TAU clinics)
study was an effectiveness, intent-to-treat,
prospective trial with the aim of assessing
whether ALGO produced better clinical outcomes
of an earlier onset and/or a greater effect
during 12-month treatment period. Outpatients,
18 years or older, with a diagnosis of major
depressive disorder entered ALGO if they were
starting antidepressant therapy or required a
change of antidepressant medication. The same
criteria were used for entrance into
TAU initially. However, since medication
changes were less frequent in the TAU group,
patients whose quarterly, routinely assessed
24-item Brief Psychiatric Rating Scale total
score was higher than the median for that
clinic, were also recruited. The clinical rating
of depressive symptoms was measured using
different scales. Quality of life and burden of
side effects were also assessed.
Both TAU and ALGO groups had significant
decreases in the 30-item Inventory of Depressive
Symptomatology Clinician Rated scale scores
during the first 3 months but the initial
decline was significantly greater for ALGO than
TAU. This advantage for ALGO over TAU persisted
throughout the subsequent 9 months.
Significantly greater symptom reduction was also
obtained in ALGO patients compared to
TAU patients on the 30-item Inventory of
Depressive Symptomatology Self Report scale, and
the12-item Short Form Health Survey mental
health score.
Although this study suffered from various
methodological limitations the results clearly
showed that self-reports corroborated clinician
ratings of the benefits of ALGO over TAU.
This suggests that it is possible to improve the
outcome of the treatment of depression in
clinical practice by extending the use of
treatment algorithms in disease management
programs. Trivedi
MH, Rush AJ, Crismon ML, Kashner TM, Toprac MG,
Carmody TJ, Key T, Biggs MM, Shores-Wilson K,
Witte B, Suppes T, Miller AL, Altshuler KZ, Shon
SP. Clinical results for patients with major
depressive disorder in the Texas Medication
Algorithm Project. Arch Gen Psychiatry 61:
669-680, 2004.