Evaluating algorithm-guided treatment for anxious depression in the German Algorithm Project (GAP)

Objective: The multi-phasic German Algorithm Project (GAP) has evaluated algorithm-guided treatment of inpatients with MDD. GAP III compared a standard stepwise drug treatment regimen (SSTR) and a computerized documentation and expert system (CDES) with treatment as usual (TAU) in a multicenter randomized controlled trial. The objective of the presented subproject is to determine the prevalence of anxious depression, to define its clinical correlates and to test the efficacy of algorithm-guided treatment in this subgroup of patients. Method: 429 inpatients treated for MDD were included. A baseline HAMD-21 Anxiety/Somatization factor score of ≥7 was considered indicative of anxious depression. We performed multivariate cox regression analysis and an analysis of interaction. Results and Discussion: Anxious depression is a relatively common subtype of MDD (48.6%). Patients with anxious MDD can be characterised by distinctive sociodemographic and clinical features: they were significantly more likely to be older and prematurely retired, to endorse higher subjective symptom severity and to experience a longer duration of the current episode. Non-anxious depression was associated with a significantly higher probability of achieving remission. As opposed to the superiority of SSTR in the total population we did not identify any significant statistical interaction which would be suggestive of different responsevity to algorithm-guided treatment in patients with anxious depression.

This study was supported by Eli Lilly, Janssen-Cilag, Pfizer, Wyeth, Pharmacia