Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project.
BACKGROUND
The Texas Medication Algorithm Project is an evaluation of an algorithm-based disease management program for the treatment of the self-declared persistently and seriously mentally ill in the public mental health sector.


OBJECTIVE
To present clinical outcomes for patients with major depressive disorder (MDD) during 12-month algorithm-guided treatment (ALGO) compared with treatment as usual (TAU).


METHODS
Effectiveness, intent-to-treat, prospective trial comparing patient outcomes in clinics offering ALGO with matched clinics offering TAU.


METHODS
Four ALGO clinics, 6 TAU clinics, and 4 clinics that offer TAU to patients with MDD but provide ALGO for schizophrenia or bipolar disorder. Patients Male and female outpatients with a clinical diagnosis of MDD (psychotic or nonpsychotic) were divided into ALGO and TAU groups. The ALGO group included patients who required an antidepressant medication change or were starting antidepressant therapy. The TAU group initially met the same criteria, but because medication changes were made less frequently in the TAU group, patients were also recruited if their Brief Psychiatric Rating Scale total score was higher than the median for that clinic's routine quarterly evaluation of each patient.


METHODS
Primary outcomes included (1) symptoms measured by the 30-item Inventory of Depressive Symptomatology-Clinician-Rated scale (IDS-C(30)) and (2) function measured by the Mental Health Summary score of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) obtained every 3 months. A secondary outcome was the 30-item Inventory of Depressive Symptomatology-Self-Report scale (IDS-SR(30)).


RESULTS
All patients improved during the study (P<.001), but ALGO patients had significantly greater symptom reduction on both the IDS-C(30) and IDS-SR(30) compared with TAU. ALGO was also associated with significantly greater improvement in the SF-12 mental health score (P =.046) than TAU.


CONCLUSIONS
The ALGO intervention package during 1 year was superior to TAU for patients with MDD based on clinician-rated and self-reported symptoms and overall mental functioning.
Trivedi
Madhukar H
MH
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, 75235, USA. madhukar.trivedi@utsouthwestern.edu
Rush
A John
AJ
Crismon
M Lynn
ML
Kashner
T Michael
TM
Toprac
Marcia G
MG
Carmody
Thomas J
TJ
Key
Tracie
T
Biggs
Melanie M
MM
Shores-Wilson
Kathy
K
Witte
Bradley
B
Suppes
Trisha
T
Miller
Alexander L
AL
Altshuler
Kenneth Z
KZ
Shon
Steven P
SP
D000328:Adult; D000368:Aged; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003155:Community Mental Health Centers; D003663:Decision Trees; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D004334:Drug Administration Schedule; D004565:Electroconvulsive Therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013781:Texas; D016896:Treatment Outcome
D000928:Antidepressive Agents; D011619:Psychotropic Drugs