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.