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. 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.

a

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

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