Efficacy of an algorithm-guided treatment compared with treatment as usual: a randomized, controlled study of inpatients with depression.
OBJECTIVE
Medication algorithms have been proposed as effective means to offer optimal treatment and improved outcome for patients with severe mental illness. This single-center prospective study compared the efficacy and effects on treatment prescriptions of an algorithm-guided treatment regimen with treatment as usual (TAU) in depressed inpatients.


METHODS
Depressed inpatient participants were randomized to an algorithm-guided standardized stepwise drug treatment regimen (SSTR, n = 74) or TAU (n = 74). The SSTR regimen included sleep deprivation, antidepressant monotherapy, lithium augmentation, monoamine oxidase inhibitor therapy, or electroconvulsive therapy guided by scores on the clinician-rated Bech-Rafaelsen Melancholia Scale. The primary outcome was time to remission (defined as a Bech-Rafaelsen Melancholia Scale score of < or =7). Secondary outcomes were remission rates, number of changes in treatment strategies (types), and the number of different prescribed medications over the treatment period.


RESULTS
Patients receiving SSTR had a significantly shorter time to remission (7.0 +/- 0.9 weeks vs 12.3 +/- 1.8 weeks for TAU). Compared with that in remitters in SSTR, the number of strategy changes was significantly higher in TAU remitters (3.0 +/- 2.7 and 1.0 +/- 1.5) and had more psychotropic medications (fix agents: 3.0 +/- 1.5 and 1.9 +/- 1.1; optional agents: 1.5 +/- 1.0 and 0.9 +/- 0.7). Although more patients dropped out of the SSTR group (33 of SSTR, 12 of TAU), the probability of remission tended to be higher in SSTR.


CONCLUSIONS
Algorithm-guided treatment produces better outcomes and less frequent medication changes than TAU. A systematic, stepwise, measurement-based approach to the treatment of depressed inpatients is warranted.
Bauer
Michael
M
Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany. michael.bauer@uniklinikum-dresden.de
Pfennig
Andrea
A
Linden
Michael
M
Smolka
Michael N
MN
Neu
Peter
P
Adli
Mazda
M
D000328:Adult; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003863:Depression / Q000523:psychology / Q000628:therapy*; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D007297:Inpatients; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D010352:Patient Dropouts; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D012892:Sleep Deprivation; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors; D016651:Lithium Carbonate