Algorithm‐guided treatment versus treatment as usual for major depression

• Published in: Psychiatry and clinical neurosciences 2009-10, Vol.63 (5), p.652-657
• Main Authors: Yoshino, Aihide, Sawamura, Takehito, Kobayashi, Nobuhisa, Kurauchi, Sachi, Matsumoto, Aki, Nomura, Soichiro
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Algorithms; algorithm‐guided treatment; Antidepressive Agents - therapeutic use; Biological and medical sciences; clinical outcome; Depression; Depressive Disorder, Major - drug therapy; Drug Therapy, Combination; Female; Humans; lithium augmentation; Lithium Compounds - therapeutic use; major depression; Male; Medical sciences; Middle Aged; Mood disorders; Neuropharmacology; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Remission Induction; treatment as usual; Treatment Outcome
• ISSN: 1323-1316; 1440-1819
• DOI: 10.1111/j.1440-1819.2009.02009.x

Aims:  The remission rates for patients with major depressive disorder (MDD) during algorithm‐guided treatment (AGT), which consisted of four treatment strategy steps were prospectively compared with treatment as usual (TAU). Methods:  The remission rates of patients with mild or moderate MDD during AGT (n = 83) were compared with TAU (n = 127). Results:  The remission rate in the AGT group (60.2%) was approximately 10% greater than that in the TAU group (49.7%). The median number of days to achieve remission in the AGT group (93 days) was half as long as that in the TAU group (191 days). The hazard ratio of remission was 1.5 (95% confidence interval: = 1.2–1.8). A higher rate of lithium augmentation in the AGT group (20.5%) compared to theTAU (4.7%) may have led to the greater remission rate. Most participants who did not achieve remission either during the initial or second treatment steps dropped out from AGT. Conclusions:  AGT may be superior to TAU for patients with mild or moderate MDD, based on the remission rates achieved. The later treatment steps in the AGT, however, were rarely utilized because participants who did not receive any benefit dropped out early.