Table 2.
Processes of Care When Using Antidepressants Under Experimental Conditions vs. Usual Care Conditions
Experimental Condition | Usual Care Condition | |
---|---|---|
Schedule of visits | Fixed; 4-6 visits over 6 weeks; 6-12 visits over 8-12 weeks. | Based on physician's and patient's availability; 2-3 visits over 12 weeks |
Duration of visits | 30-60 minutes. | 10-20 minutes. |
Treatment protocol | Predetermined; minimal adaptations based on patient's characteristics (e.g., slower titration for frail patients). | Individualized for each patient based on their characteristics and preferences. |
Selection of antidepressant | Small number of antidepressants preselected based on best evidence or guidelines and used in all patients. | Large number of antidepressants, each used in a small number of patients; matching patient's clinical characteristics with perceived features of specific antidepressants. |
Dose titration and change in treatment | Predetermined; based on operationalized criteria, protecting clinicians from personal biases or pressures from patients or their families. | Negotiated at each visit with each patient based on perceived adverse effects or lack of improvement. Changes often ill-advised or ill-timed. |
Monitoring of symptoms and adverse effects | Systematic monitoring with use of structured interviews and validated scales. | Monitoring based on spontaneous reports and ad-hoc clinical interviews. |
Main focus of clinical interactions | Maximizing treatment adherence with psychoeducation, characterization of changes in patient's symptoms, management of adverse effects. | Negotiating whether and how antidepressants should be used, titrated up or down, switched, or augmented; selection of augmenting or alternative agents. |