Figure 1.

Two-step Dopaminergic Antidepressant Therapy Algorithm (DATA) for treatment resistant anergic-anhedonic depression (TRAD). Lead-in/preparation period: patients who accepted were first proposed to stop or reduce D2 receptor blockers and to introduce a mood stabilizer (preferably lithium). DATA1 (first step): patients were advised to switch to a non-selective (irreversible) monoamine oxidase inhibitor (MAOI – first choice). The add-on of dopamine D2 receptor agonist (D2RAG) to current antidepressant (classical) was presented as the second choice. DATA2 (second step): all non-remitters or patients who did not feel like before were proposed to combine MAOI and D2RAG. At each step, the prescriber was allowed to change molecules within the same class and adapt titration speed to optimize tolerance. Evaluations with QIDS were performed after sufficient stability to allow management decisions to maintain, stop, or combine treatments.