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Pharmacopsychiatry 2019; 52(03): 117-125
DOI: 10.1055/a-0643-4830
Review
© Georg Thieme Verlag KG Stuttgart · New York

Algorithms For Treatment of Major Depressive Disorder: Efficacy and Cost-Effectiveness

Michael Bauer
1   Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
,
A. John Rush
2   Duke-National University of Singapore, Singapore
3   Department of Psychiatry, Duke University Medical School, Durham, NC, USA
4   Department of Psychiatry, Texas Tech Health Science Center, Permian Basin, TX, USA
,
Roland Ricken
5   Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Germany
,
Maximilian Pilhatsch
1   Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
,
Mazda Adli
5   Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Germany
6   Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
› Author Affiliations
Further Information

Publication History

received 15 May 2018
revised 07 June 2018

accepted 07 June 2018

Publication Date:
09 July 2018 (online)

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Abstract

In spite of multiple new treatment options, chronic and treatment refractory courses still are a major challenge in the treatment of depression. Providing algorithm-guided antidepressant treatments is considered an important strategy to optimize treatment delivery and avoid or overcome treatment-resistant courses of major depressive disorder (MDD). The clinical benefits of algorithms in the treatment of inpatients with MDD have been investigated in large-scale, randomized controlled trials. Results showed that a stepwise treatment regimen (algorithm) with critical decision points at the end of each treatment step based on standardized and systematic measurements of response and an algorithm-guided decision-making process increases the chances of achieving remission and optimizes prescription behaviors for antidepressants. In conclusion, research in MDD revealed that systematic and structured treatment procedures, the diligent assessment of response at critical decision points, and timely dose and treatment type adjustments make the substantial difference in treatment outcomes between algorithm-guided treatment and treatment as usual.

Key words

treatment algorithm - outcome - treatment as usual - medical decision-making
 

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