Evaluating algorithm-guided treatment for depression: The German Algorithm Project (GAP)

The introduction of algorithms in the treatment of patients suffering from major depressive disorder (MDD) is considered as an important instrument in avoiding and overcoming treatment-resistant depression. The multiphasic German Algorithm Project has evaluated algorithm-guided treatment of inpatients with MDD. Phase I (open observational trial) showed a moderate acceptance but good clinical effectiveness of a standardized stepwise drug treatment regimen (SSTR). Phase II (randomized controlled trial) demonstrated a higher probability of achieving remission for SSTR patients compared to patients with treatment as usual (TAU). Phase III was a recently finished randomized controlled multi-center trial within the German Research Network on Depression which compared an SSTR and a computerized documentation and expert system (CDES) with TAU. Within the SSTR we compared three different second-step strategies in the case of non-response to an initial antidepressant monotherapy (SSTR1: lithium augmentation, SSTR 2: dose escalation, SSTR 3: switch to other compound). Preliminary analyses show a faster remission for algorithm-treated patients compared to TAU (F=3.045; p=0.18) with SSTR1 showing the greatest difference to TAU (p=0.02). TAU was associated with a higher average rate of residual symptoms at the end of treatment. Algorithm-guided treatment of depression may lead to a faster remission and reduce hospitalization times, particularly with an SSTR including lithium augmentation.