Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-17T08:04:15.750Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of Decision Support Tools for Treatment Algorithms

Published online by Cambridge University Press:  07 November 2014

Madhukar H. Trivedi
Get access Rights & Permissions [Opens in a new window]

Extract

Major depressive disorder (MDD) is a highly prevalent, debilitating disorder that is often chronic, recurrent, and costly, with the economic burden in the United States for the year 2000 exceeding $83 billion. Recent data from the National Comorbidity Survey Replication (NCS-R) indicate that MDD has a lifetime prevalence of 16.2% and a 12-month prevalence of 6.6% in the US. Among those reporting at least one episode of MDD in the previous 12 months, mean episode duration was 16 weeks. Roughly 60% of patients experienced role impairment that was “severe” or “very severe,” and nearly 80% reported comorbid disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, with MDD only rarely being primary. Although 51.6% of patients with MDD received health care treatment for the illness, treatment was “adequate,” as defined by the Agency for Health Care Policy and Research and the American Psychiatric Association guidelines (ie, ≥4 outpatient visits with any type of physician for pharmacotherapy that included use of either an antidepressant or a mood stabilizer for ≥30 days or ≥8 outpatient visits with any professional in the specialty mental health sector for psychotherapy lasting a mean of ≥30 visits) in 41.9% of treated cases. Only 21.6% of all MDD patients in the NCS-R, therefore, received minimal guideline-level treatment.

Type
Clinical Information Supplement
Information
CNS Spectrums , Volume 12 , Issue S13: Consensus Recommendations for Improving Adherence, Self-management, and Outcomes in Patients with Depression , August 2007 , pp. 9 - 16
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Greenberg, PE, Kessler, RC, Birnbaum, HG et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64:1465–1475.CrossRefGoogle ScholarPubMed
2.Kessler, RC, Berglund, P, Demler, O et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095–3105.CrossRefGoogle ScholarPubMed
3.Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Second Edition. Arlington, VA: American Psychiatric Association; 2000;vii–87.Google Scholar
4.Clinical Practice Guideline Number 5: Depression in Primary Care, 2. Treatment of Major Depression. Rockville, Md: Agency for Health Care and Policy Research: US Dept of Health and Human Services; 1993. AHCPR publication 93–0551.Google Scholar
5.Mueller, TI, Leon, AC. Recovery, chronicity, and levels of psychopathology in major depression. Psychiatr Clin North Am. 1996;19:85–102.CrossRefGoogle ScholarPubMed
6.Keller, MB, Harrison, W, Fawcett, JA et al. , Treatment of chronic depression with sertraline or imipramine: preliminary blinded response rates and high rates of undertreatment in the community. Psychopharmacol Bull. 1995;31:205–212.Google ScholarPubMed
7.Trivedi, MH, Rush, AJ, Wisniewski, SR et al. , Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163:28–40.CrossRefGoogle ScholarPubMed
8.Frank, E, Karp, JF, Rush, AJ. Efficacy of treatments for major depression. Psychopharmacol Bull. 1993;29:457–475.Google ScholarPubMed
9.Fava, M, Davidson, KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am. 1996;19:179–200.CrossRefGoogle ScholarPubMed
10.Miller, IW, Keitner, GI, Schatzberg, AF et al. The treatment of chronic depression, part 3: psychosocial functioning before and after treatment with sertra-line or imipramine. J Clin Psychiatry. 1998;59:608–619.CrossRefGoogle ScholarPubMed
11.Judd, LL, Paulus, MP, Wells, KB, Rapaport, MH. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psychiatry. 1996;153:1411–1417.Google Scholar
12.Judd, LL, Akiskal, HS, Zeller, PJ et al. , Psychosocial disability during the long-term course of unipolar major depressive disorder. Arch Gen Psychiatry. 2000;57:375–380.CrossRefGoogle ScholarPubMed
13.Judd, LL, Akiskal, HS, Maser, JD et al. , Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord. 1998;50:97–108.CrossRefGoogle ScholarPubMed
14.Judd, LL, Paulus, MJ, Schettler, PJ et al. , Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry. 2000;157:1501–1504.CrossRefGoogle Scholar
15.Van Londen, L, Molenaar, RP, Goekoop, JG, Zwinderman, AH, Rooijmans, HG. Three- to 5-year prospective follow-up of outcome in major depression. Psychol Med. 1998;28:731–735.CrossRefGoogle ScholarPubMed
16.Mueller, TI, Leon, AC, Keller, MB et al. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry. 1999;156:1000–1006.CrossRefGoogle ScholarPubMed
17.Diagnostic and Statistical Manual of Mental Disorders. 4th ed text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
18.Kessler, RC, McGonagle, KA, Zhao, S et al. , Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.CrossRefGoogle ScholarPubMed
19.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
20.Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.CrossRefGoogle ScholarPubMed
21.Keller, MB, Lavori, PW, Endicott, J, Coryell, W, Klerman, GL. “Double depression”: two-year follow-up. Am J Psychiatry. 1983;140:689–694.Google ScholarPubMed
22.Keller, MB, Hirschfeld, RM, Hanks, D. Double depression: a distinctive subtype of unipolar depression. J Affect Disord. 1997;45:65–73.CrossRefGoogle ScholarPubMed
23.Simon, GE. Long-term prognosis of depression in primary care. Bull World Health Organ. 2000;78:439–445.Google ScholarPubMed
24.Trivedi, MH. Treatment-resistant depression: new therapies on the horizon. Ann Clin Psychiatry. 2003;15:59–70.CrossRefGoogle ScholarPubMed
25.Solomon, DA, Leon, AC, Mueller, TI et al. , Tachyphylaxis in unipolar major depressive disorder. J Clin Psychiatry. 2005;66:283–290.CrossRefGoogle ScholarPubMed
26.Thase, ME. New approaches to managing difficult-to-treat depressions. J Clin Psychiatry. 2003;64(Suppl 1):3–4.Google ScholarPubMed
27.Quitkin, FM, McGrath, PJ, Stewart, JW et al. Remission rates with 3 consecutive antidepressant trials: effectiveness for depressed outpatients. J Clin Psychiatry. 2005;66:670–676.CrossRefGoogle ScholarPubMed
28.Schatzberg, AF, Rush, AJ, Arnow, BA et al. , Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not. Arch Gen Psychiatry. 2005;62:513–520.CrossRefGoogle ScholarPubMed
29.Zajecka, JM. Clinical issues in long-term treatment with antidepressants. J Clin Psychiatry. 2000;61(Suppl 2):20–25.Google ScholarPubMed
30.Thase, ME, Rush, AJ. When at first you don't succeed: sequential strategies for antidepressant nonresponders. J Clin Psychiatry. 1997;58(suppl 13):23–29.Google ScholarPubMed
31.Cadieux, RJ. Practical management of treatment-resistant depression. Am Fam Physician. 1998;58:2059–2062.Google ScholarPubMed
32.Nurnberg, HG, Thompson, PM, Hensley, PL. Antidepressant medication change in a clinical treatment setting: a comparison of the effectiveness of selective serotonin reuptake inhibitors. J Clin Psychiatry. 1999;60:574–579.CrossRefGoogle Scholar
33.Kroenke, K, West, SL, Swindle, R et al. , Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA. 2001;286:2947–2955.CrossRefGoogle ScholarPubMed
34.Fredman, SJ, Fava, M, Kienke, AS, White, CN, Nierenberg, AA, Rosenbaum, JF. Partial response, nonresponse, and relapse with selective serotonin reuptake inhibitors in major depression: a survey of current “next-step” practices. J Clin Psychiatry. 2000;61:403–408.CrossRefGoogle ScholarPubMed
35.Nelson, JC. Augmentation strategies in depression 2000. J Clin Psychiatry. 2000;61(Suppl 2):13–19.Google ScholarPubMed
36.Nelson, JC. Overcoming treatment resistance in depression. J Clin Psychiatry. 1998;59:13–19.Google ScholarPubMed
37.Thase, ME. What role do atypical antipsychotic drugs have in treatment-resistant depression? J Clin Psychiatry. 2002;63:95–103.CrossRefGoogle ScholarPubMed
38.Trivedi, MH, Kleiber, BA. Algorithm for the treatment of chronic depression. J Clin Psychiatry. 2001;62:22–29.Google ScholarPubMed
39.Trivedi, MH. Using treatment algorithms to bring patients to remission. J Clin Psychiatry. 2003;64(Suppl 2):8–13.Google ScholarPubMed
40.Crismon, ML, Trivedi, M, Pigott, TA et al. , The Texas Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Major Depressive Disorder. J Clin Psychiatry. 1999;60:142–156.CrossRefGoogle ScholarPubMed
41.Katon, W, Von Korff, M, Lin, E et al. , Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273:1026–1031.CrossRefGoogle ScholarPubMed
42.Rush, AJ, Crismon, ML, Toprac, MG et al. , Implementing guidelines and systems of care: experiences with the Texas Medication Algorithm Project (TMAP). J Pract Psychiatry Behav Health. 1999;5:75–86.CrossRefGoogle Scholar
43.Rush, AJ, Crismon, ML, Kashner, TM et al. , Texas Medication Algorithm Project, phase 3 (TMAP-3): rationale and study design. J Clin Psychiatry. 2003;64:357–369.CrossRefGoogle ScholarPubMed
44.Trivedi, MH, Rush, AJ, Crismon, ML et al. , Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project. Arch Gen Psychiatry. 2004;61:669–680.CrossRefGoogle ScholarPubMed
45.Biggs, MM, Shores-Wilson, K, Rush, AJ et al. , A comparison of alternative assessments of depressive symptom severity: a pilot study. Psychiatry Res. 2000;96:269–279.CrossRefGoogle ScholarPubMed
46.Trivedi, MH, Rush, AJ, Gaynes, BN et al. , Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D Measurement-Based Care. Neuropsychopharmacology. 2007. Apr 4 [Epub ahead of print]CrossRefGoogle ScholarPubMed
47.Rush, AJ, Fava, M, Wisniewski, SR et al. , Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials. 2004;25:119–142.CrossRefGoogle ScholarPubMed
48.Clinical Practice Guideline Number 5: Depression in Primary Care, 1: Detection and Diagnosis. Rockville, Md: Agency for Health Care and Policy Research, US Dept of Health and Human Services; 1993. AHCPR publication 93–0550.Google Scholar
49.Trivedi, MH, Claassen, CA, Grannemann, BD et al. , Assessing physicians' use of treatment algorithms: Project IM PACTS study design and rationale. Contemp Clin Trials. 2007;28:192–212.CrossRefGoogle Scholar
50.Gilbert, DA, Altshuler, KZ, Rago, WV et al. , Texas Medication Algorithm Project: definitions, rationale, and methods to develop medication algorithms. J Clin Psychiatry. 1998;59:345–351.CrossRefGoogle ScholarPubMed
51.Rush, AJ, Rago, WV, Crismon, ML et al. , Medication treatment for the severely and persistently mentally ill: the Texas Medication Algorithm Project. J Clin Psychiatry. 1999;60:284–291.CrossRefGoogle ScholarPubMed
52.Glasgow, RE, Bull, SS, Piette, JD, Steiner, JF. Interactive behavior change technology. A partial solution to the competing demands of primary care. Am J Prev Med. 2004;27:80–87.CrossRefGoogle Scholar
53.Trivedi, MH, Kern, JK, Baker, SM, Altshuler, KZ. Computerizing medication algorithms and decision support systems for major psychiatric disorders. J Psychiatr Pract. 2000;6:237–246.CrossRefGoogle ScholarPubMed
54.Trivedi, MH, Kern, JK, Grannemann, BD, Altshuler, KZ, Sunderajan, P. A computerized clinical decision support system as a means of implementing depression guidelines. Psychiatr Serv. 2004;55:879–885.CrossRefGoogle ScholarPubMed
55.Sequenced Treatment Alternatives to Relieve Depression (Star*D) study. National Institute of Mental Health and University of Pittsburgh Epidemiology Data Center. Available at: http://www.edc.pitt.edu/stard/ Accessed March 28, 2007.Google Scholar
56.Kupfer, DJ. Long-term treatment of depression. J Clin Psychiatry. 1991;52(suppl):28–34.Google ScholarPubMed
57.Streja, DA, Hui, RL, Streja, E, McCombs, JS. Selective contracting and patient outcomes: a case study of formulary restrictions for selective serotonin reup-take inhibitor antidepressants. Am J Manag Care. 1999;5:1133–42.Google Scholar
58.Russell, JM, Berndt, ER, Miceli, R, Colucci, S, Grudzinski, AN. Course and cost of treatment for depression with fluoxetine, paroxetine, and sertraline. Am J Manag Care. 1999;5:597–606.Google ScholarPubMed
59.Melfi, CA, Chawla, AJ, Croghan, TW, Hanna, MP, Kennedy, S, Sredl, K. The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Arch Gen Psychiatry. 1998;55:1128–1132.CrossRefGoogle ScholarPubMed
60.Lin, EH, Von Korff, M, Katon, W et al. , The role of the primary care physician in patients' adherence to antidepressant therapy. Med Care. 1995;33:67–74.CrossRefGoogle ScholarPubMed