An algorithm for the pharmacological treatment of depression.
OBJECTIVE
Non-response to treatment with antidepressants (AD) is a clinical problem.


METHODS
The algorithm for pharmacological treatment of the Dutch multidisciplinary guideline for depression is compared with four other algorithms.


RESULTS
The Dutch algorithm consists of five subsequent steps. Treatment is started with one out of many optional ADs (step 1); in case of non-response after 4-10 weeks, best evidence is for switching to another AD (step 2); next step is augmentation with lithium as the best option (step 3); the next step is a monoamine oxidase inhibitor (MAOI) (step 4); and finally electroconvulsive therapy (step 5). There are major differences with other algorithms regarding timing of augmentation step, best agents for augmentation and role of MAOI.


CONCLUSIONS
Algorithms for AD treatment vary according to national and local preferences. Although the evidence for most of the treatment strategies is rather meagre, an AD algorithm appears to be an useful instrument in clinical practice.
Spijker
J
J
De Gelderse Roos, Mental Health Care, Ede, the Netherlands. JSpijker@trimbos.nl
Nolen
W A
WA
D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004351:Drug Resistance / Q000187:drug effects*; D004565:Electroconvulsive Therapy; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D016239:MEDLINE; D015201:Meta-Analysis as Topic; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D009426:Netherlands; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
D000928:Antidepressive Agents; D018692:Antimanic Agents; D008996:Monoamine Oxidase Inhibitors; D008094:Lithium