Table 1.

GermanIMPACT stepped-care algorithm

Change of current PHQ score compared to baseline	Recommended step
Improvement of less than 50% (including no improvement and worsening of symptoms)	a) Medication-related changes (initiated by the GP) including initiation if patient is currently without medication, or
	b) Training of problem-solving techniques provided by the care manager: two face-to-face sessions, four telephone sessions (approximately 45 minutes each); afterwards resumption of telephone sessions at two-week intervals
Improvement of 50% or more	No treatment changes
PHQ-9 score <5 (remission)	c) Discussion of a relapse prevention and emergency plan
	d) Reduction of telephone sessions to four-week intervals; in case of relapse, resumption of telephone sessions at two-week intervals