Figure 1.

Patient flowchart. *In level 2, 580 patients were randomised to switch medications, 441 to medication augmentation, and 113 to cognitive therapy as either a switch or medication augmentation treatment. In level 2A, 28 patients were randomised to one of two level 2 switch medications. For step 3/level 3 patients, 186 were randomised to medication switch and 111 to medication augmentation. For step 4/level 3 patients, seven were randomised to medication switch and nine to medication augmentation. For step 4/level 4 patients, 90 were randomised to one of two medication/medication combination switch options. **Exit refers to the number of patients who exit the study and do not proceed either to the next treatment level nor enter follow-up. ***Follow-up refers to the number of patients who exit a treatment and enter the 12-month follow-up phase. HRSD, Hamilton Rating Scale for Depression.