. Author manuscript; available in PMC: 2009 Dec 14.

Published in final edited form as: Drug Alcohol Depend. 2007 Feb 22;88(Suppl 2):S61–S71. doi: 10.1016/j.drugalcdep.2007.01.007

Table 1. Measurement-Based Care and Tactics for Acute Phase Treatment of Major Depressive Disorder.

Critical Decision Point (CDP)	Clinical Status		Plan
Week 0 (CDP #1)	HAM-D₁₇ ≥ 14	Symptomatic	Initiate medication; adjust dose to lower end of therapeutic dose range or serum level.

Week 4 (CDP #2)	QIDS-C₁₆ ≤5	Remission	Continue current dose.

	QIDS-C₁₆ = 6-8	Partial Response	Continue current dose. Consider increasing dose.

		SEs intolerable	Continue current dose and address SEs. Switch to another antidepressant.

	QIDS-C₁₆ ≥9	Nonresponse	Increase dose. Switch to another antidepressant.

		SEs intolerable	Switch to another antidepressant.

Week 6 (CDP #3)	QIDS-C₁₆ ≤5	Remission	Continue current dose.

	QIDS-C₁₆ = 6-8	Partial Response	Increase/maximize dose. Use augmentation.

		SEs intolerable	Continue current dose and address SEs. Switch to another antidepressant.

	QIDS-C₁₆ ≥9	Nonresponse	Use augmentation. Switch to another antidepressant.

		SEs intolerable	Switch to another antidepressant.

Week 9 CDP #4)	QIDS-C₁₆ ≤5	Remission	Continue current dose.

	QIDS-C₁₆ = 6-8	Partial Response	Increase dose. Use augmentation. Switch to another antidepressant.

	QIDS-C₁₆ ≥9	Nonresponse or SEs intolerable	Switch to another antidepressant.

Week 12 (CDP #5)	QIDS-C₁₆ ≤5	Remission	Go to follow-up phase.

	QIDS-C₁₆ = 6-8	Partial Response	Switch to another antidepressant. Increase dose and reevaluate in 2 weeks.^a

	QIDS-C₁₆ ≥9	Nonresponse or SEs intolerable	Switch to another antidepressant.

If after 12 weeks the patient has not remitted, but the clinician feels that 2 more weeks of treatment would be beneficial, treatment may be extended.

QIDS-C₁₆, 16-item Quick Inventory of Depressive Symptomatology – Clinician-rated; SEs, side effects; HAM-D₁₇, 17-item Hamilton Depression Rating Scale