How to Use Treatment Algorithms for the Effective Management of Treatment-Resistant Depression

Some people do not respond well to medical intervention for depression. While others respond favorably and rid themselves of depression, others do not. These patients are classified as having treatment-resistant depression (TRD). An algorithm-based treatment (a strategy of protocols and procedures) can be a viable treatment option for TRD. When using an algorithm, the physician uses a set of "if-then" steps. For example, if the patient has been on an antidepressant less than six weeks, then treat at the same dose. Each step is measurable by time, medication dose or self-report scales.

Instructions

• 1

  Rule out underlying health conditions that may be interfering with treatment. Test for any suspect illnesses. Determine if the patient is compliant with treatment. Ask if he is taking his medications as prescribed. Inquire if she is going to her therapy sessions. Invite the patient to share if any issues that are exacerbating TRD such as divorce, death of a loved one or losing one's home.

• 2

  Stabilize the patient if a positive diagnosis is made for any of the diagnosing factors in step one. Give time for adequate treatment with an antidepressant if a negative diagnosis is made. Dose high enough to be in a therapeutic range.

• 3

  Give antidepressants for six to eight weeks more if the patient has been treated for less than six weeks. Dose at maximum strength. Go to the next step if the patient has had an adequate period of antidepressant therapy.

• 4

  Switch the medication (if there was no response to the antidepressant therapy). Start over through the algorithm. Repeat until an effective treatment is found. Try electroconvulsive therapy (ECT) if there still is no response after several pharmacological trials.

• 5

  Augment and combine medication when a patient has a partial response to the antidepressant. Use tricyclics, selective serotonin re-uptake inhibitors (SSRIs), atypical antidepressants, monoamine oxidase inhibitors or teracycles. Consider ECT if this strategy doesn't work.

• 6

  Use a measurable algorithm to treat TRD. Employing one yields better results than treatment as usual. Choose from several variations of a similar algorithm. Recognize that the main component of these algorithms relies heavily on pharmacology.