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

Michael Bauer; A. John Rush; Roland Ricken; Maximilian Pilhatsch; Mazda Adli

doi:10.1055/a-0643-4830

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2019; 52(03): 117-125
DOI: 10.1055/a-0643-4830

Review

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

Michael Bauer

¹Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany

,

A. John Rush

²Duke-National University of Singapore, Singapore

³Department of Psychiatry, Duke University Medical School, Durham, NC, USA

⁴Department of Psychiatry, Texas Tech Health Science Center, Permian Basin, TX, USA

,

Roland Ricken

⁵Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Germany

,

Maximilian Pilhatsch

¹Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany

,

Mazda Adli

⁵Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Germany

⁶Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany

› Author Affiliations

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

Full Text

References

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