Pharmacopsychiatry 2003; 36: 222-229
DOI: 10.1055/s-2003-45134
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Algorithms for Optimizing the Treatment of Depression: Making the Right Decision at the Right Time

M. Adli1 , A. J. Rush2 , H.-J. Möller3 , M. Bauer1
  • 1Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Charité-Mitte (CCM), Berlin, Germany
  • 2Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  • 3Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, München, Germany
Further Information

Publication History

Publication Date:
15 December 2003 (online)

Medication algorithms for the treatment of depression are designed to optimize both treatment implementation and the appropriateness of treatment strategies. Thus, they are essential tools for treating and avoiding refractory depression. Treatment algorithms are explicit treatment protocols that provide specific therapeutic pathways and decision-making tools at critical decision points throughout the treatment process. The present article provides an overview of major projects of algorithm research in the field of antidepressant therapy. The Berlin Algorithm Project and the Texas Medication Algorithm Project (TMAP) compare algorithm-guided treatments with treatment as usual. The Sequenced Treatment Alternatives to Relieve Depression Project (STAR*D) compares different treatment strategies in treatment-resistant patients.

References

  • 1 Adli M, Berghöfer A, Linden M, Helmchen H, Müller-Oerlinghausen B, Mackert A, Stamm T; Bauer M. Effectiveness and feasibility of a standardized stepwise drug treatment algorithm for inpatients with depressive disorders - results of a two-year observational study.  J Clin Psychiatr. 2002;  63 782-790
  • 2 Adli M, Kießlinger U, Linden M, Neu P, Smolka M, Bauer M. Evaluation of a Systematic Treatment Algorithm for Depressive Disorders: How Effective Are the Different Treatment Steps? A Randomized Controlled Study by the Berlin Algorithm Study Group [abstract]. 154th Annual Meeting, American Psychiatric Association May 5 - 10, 2001 New Orleans, USA;
  • 3 Agency for Health Care Policy and Research ( AHCPR). Treatment of depression - newer pharmacotherapies. Summary, evidence report/ Technology Assessment: No. 7. AHCPR pub. No. 99 - 0580. Rockville, MD; 1999
  • 4 Bauer M, Adli M, Kiesslinger U, Neu P, Smolka M, Linden M. Algorithm-guided treatment vs. treatment as usual: randomized trial in inpatients with depression [abstract]. 154th Annual Meeting. American Psychiatric Association May 5 - 10, 2001 New Orleans, USA;
  • 5 Bauer M, Whybrow P C, Angst J, Versiani M, Möller H J. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders, Part 1: acute and continuation treatment of major depressive disorder.  World J Biol Psychiatr. 2002;  3 5-43
  • 6 Bauer M, Döpfmer S. Lithium augmentation in treatment-resistant depression - a meta-analysis of placebo-controlled studies.  J Clin Psychopharmacol. 1999;  19 427-434
  • 7 Bech P, Rafaelsen O J. The melancholia scale: development, consistency, validity and utility. In Sartorius N, Ban TA, eds Assessment of Depression. Berlin Heidelberg; Springer 1986: 259-269
  • 8 Faltermaier-Temizel M, Laakmann G, Baghai T, Kuhn K. Prädiktive Faktoren für den Therapieerfolg beim depressiven Syndrom.  Nervenarzt. 1997;  68 62-66
  • 9 Fava M, Rush A J, Trivedi M H, Nierenberg A A, Thase M E, Sackeim H A, Quitkin F M, Wisniewski S, Lavori P W, Rosenbaum J F, Kupfer D J. Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study.  Psychiatr Clin North Am. 2003;  26 457-494
  • 10 Flint A J, Rifat S L. The effect of sequential antidepressant treatment on geriatric depression.  J Affect Dis. 1996;  36 95-105
  • 11 Frye M A, Ketter T A, Leverich G S, Huggins T, Lantz C, Denicoff K D, Post R M. The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study.  J Clin Psychiatr. 2000;  61 9-15
  • 12 Greenberg P E, Stiglin L E, Finkelstein S N, Berndt E R. The economic burden of depression in 1990.  J Clin Psychiatr. 1993;  54 405-418
  • 13 Hawley C J, Pattinson H A, Quick S J, Echlin D, Smith V, McPhee S, Sivakumaran T. A protocol for the pharmacologic treatment of major depression. A field test of a potential prototype.  J Affect Dis. 1998;  47 87-96
  • 14 Helmchen H. Current trends of research on antidepressive treatment and prophylaxis.  Compr Psychiat. 1979;  20 201-214
  • 15 Judd L L, Akiskal H S, Maser J D, Zeller P J, Endicott J, Coryell W, Paulus M P, Kunovac J L, Leon A C, Mueller T I, Rice J A, Keller M B. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders.  Arch Gen Psychiatr. 1998;  55 694-700
  • 16 Katon W, Von Korff M, Lin E, Walker E, Simon G E, Bush T, Robinson P, Russo J. Collaborative management to achieve treatment guidelines. Impact on depression in primary care.  JAMA. 1995;  273 1026-1031
  • 17 Klerman G L, Weissman M M. The course, morbidity, and costs of depression.  Arch Gen Psychiatr. 1992;  49 831-834
  • 18 Lavori P W, Rush A J, Wisniewski S, Alpert J, Fava M, Kupfer D J, Nierenberg A, Quitkin F M, Sackeim H A, Thase M E, Trivedi M. Strengthening clinical effectiveness trials: Equipoise-stratified randomization.  Biol Psychiatr. 2001;  50 792-801
  • 19 Linden M. Therapeutic standards in psychopharmacology and medical decision making.  Pharmacopsychiat. 1994;  27 (suppl) 41-45
  • 20 Linden M, Helmchen H, Mackert A, Müller-Oerlinghausen B. Structure and feasibility of a standardized stepwise drug treatment regimen (SSTR) for depressed inpatients.  Pharmacopsychiat. 1994;  27 (suppl) 51-53
  • 21 Mintz J, Mintz L I, Arruda M J, Hwang S S. Treatments of depression and functional capacity to work.  Arch Gen Psychiatr. 1992;  49 761-768
  • 22 Möller H J. Therapieresistenz unter Antidepressiva: Definition, Epidemiologie und Risikofaktoren. In: Bauer M, Berghöfer A, eds Therapieresistente Depressionen - Aktueller Wissensstand und Leitlinien für die Behandlung in Klinik und Praxis. Berlin Heidelberg New York; Springer 1997: 3-15
  • 23 Murray C JL, Lopez A D. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.  Lancet. 1997;  349 1436-1442
  • 24 Nierenberg A A, Amsterdam J D. Treatment-resistant depression: definition and treatment approaches.  J Clin Psychiatr. 1990;  51 (6, suppl) 39-47
  • 25 Nolen W A, Haffmans J. Treatment of resistant depression. Review on the efficacy of various biological treatments, specifically in major depression resistant to cyclic antidepressants.  Int Clin Psychopharmacol. 1989;  4 217-228
  • 26 Paykel E S, Ramana R, Cooper Z, Hayhurst H, Kerr J, Barocka A. Residual symptoms after partial remission: an important outcome in depression.  Psychol Med. 1995;  25 1171-1180
  • 27 Paykel E S, Scott J, Teasdale J D, Johnson A L, Garland A, Moore R, Jenaway A, Cornwall P L, Hayhurst H, Abbott R, Pope M. Prevention of relapse in residual depression by cognitive therapy. A controlled trial.  Arch Gen Psychiatr. 1999;  56 829-835
  • 28 Regier D A, Narrow W E, Rae D S, Manderscheid R W, Locke B Z, Goodwin F K. The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.  Arch Gen Psychiatr. 1993;  50 85-94
  • 29 Rush A J, Rago W V, Crismon M L, Toprac M G, Shon S P, Suppes T, Miller A L, Trivedi M H, Swann A C, Biggs M M, Shores-Wilson K, Kashner T M, Pigott T, Chiles J A, Gilbert D A, Altshuler K Z. Medication treatment for the severely and persistently ill: the Texas medication algorithm project.  J Clin Psychiatry. 1999;  60 284-291
  • 30 Rush A J. Preface. In: Rush AJ, ed Mood Disorders. Systematic Medication Management. Modern Problems of Pharmacopsychiatry. Vol. 25 Basel; Karger 1997: VII-VIII
  • 31 Rush A J, Gullion C M, Basco M R, Jarrett R B, Trivedi M H. The inventory of depressive symptomatology (IDS): Psychometric properties.  Psychol Med. 1996;  26 477-486
  • 32 Rush A J, Crismon M L, Kashner T M, Toprac M G, Carmody T J, Trivedi M , Suppes T, Miller A L, Biggs M M, Shores-Wilson K, Witte B, Shon S P, Rago W V, Altshuler K Z. Texas Medication Algorithm Project, Phase 3 (TMAP-3): Rationale and Study Design.  J Clin Psychiatry. 2003;  64 357-69
  • 33 Rush A J, Fava M, Wisniewski S R, Lavori P W, Trivedi M, Sackeim H A, Thase M E, Nierenberg A A, Quitkin F M, Kashner T M, Kupfer D J, Rosenbaum J F, Alpert J, Stewart J, McGrath P J, Biggs M M, Shores-Wilson K, O’Neal B L, Lebowitz B D, Ritz A L, Niederehe G, for the STAR*D Investigators G roup. Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design. Control Clin Trials, in press
  • 34 Thase M E, Rush A J. Treatment-resistant depression. In Bloom FE, Kupfer DJ, eds Psychopharmacology: The Fourth Generation of Progress. New York; Raven Press 1995: 1081-1097
  • 35 Trivedi M H, Rush A J, MD, Crismon M L, Kashner T M, Toprac M G, Carmody T J, Key T, Biggs M M, Shores-Wilson K, Witte B, Suppes T, Miller A L, Altshuler K Z, Shon S P. Texas Medication Algorithm Project (TMAP): Clinical Results for Patients with Major Depressive Disorder. Submitted
  • 36 Ware J E, Kosinski M, Keller S D. A 12-item short form health survey (SF-12): construction of scales and preliminary tests of reliability and validity.  Med Care. 1996;  34 220-233

Mazda Adli, MD

Charité - University Medicine Berlin

Campus Charité-Mitte (CCM)

Schumannstr. 20/21

10117 Berlin

Germany

Phone: +4-30-450-517 146

Fax: 030-450-517 962

Email: mazda.adli@charite.de

    >