Algorithm-guided treatment versus treatment as usual for major depression.
OBJECTIVE
The remission rates for patients with major depressive disorder (MDD) during algorithm-guided treatment (AGT), which consisted of four treatment strategy steps were prospectively compared with treatment as usual (TAU).


METHODS
The remission rates of patients with mild or moderate MDD during AGT (n = 83) were compared with TAU (n = 127).


RESULTS
The remission rate in the AGT group (60.2%) was approximately 10% greater than that in the TAU group (49.7%). The median number of days to achieve remission in the AGT group (93 days) was half as long as that in the TAU group (191 days). The hazard ratio of remission was 1.5 (95% confidence interval: = 1.2-1.8). A higher rate of lithium augmentation in the AGT group (20.5%) compared to the TAU (4.7%) may have led to the greater remission rate. Most participants who did not achieve remission either during the initial or second treatment steps dropped out from AGT.


CONCLUSIONS
AGT may be superior to TAU for patients with mild or moderate MDD, based on the remission rates achieved. The later treatment steps in the AGT, however, were rarely utilized because participants who did not receive any benefit dropped out early.
Yoshino
Aihide
A
Department of Psychiatry, National Defense Medical College, Saitama, Japan. aihide@ndmc.ac.jp
Sawamura
Takehito
T
Kobayashi
Nobuhisa
N
Kurauchi
Sachi
S
Matsumoto
Aki
A
Nomura
Soichiro
S
D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome
D000928:Antidepressive Agents; D018020:Lithium Compounds