Algorithm-guided treatment versus treatment as usual for major depression
Article first published online: 10 AUG 2009
© 2009 The Authors. Journal compilation © 2009 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences
Volume 63, Issue 5, pages 652–657, October 2009
How to Cite
Yoshino, A., Sawamura, T., Kobayashi, N., Kurauchi, S., Matsumoto, A. and Nomura, S. (2009), Algorithm-guided treatment versus treatment as usual for major depression. Psychiatry and Clinical Neurosciences, 63: 652–657. doi: 10.1111/j.1440-1819.2009.02009.x
- Issue published online: 23 SEP 2009
- Article first published online: 10 AUG 2009
- Received 29 August 2008; revised 2 June 2009; accepted 5 June 2009.
- algorithm-guided treatment;
- clinical outcome;
- lithium augmentation;
- major depression;
- treatment as usual
Aims: 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 theTAU (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.