A PROTOCOL FOR THE PHARMACOLOGICAL TREATMENT OF MAJOR DEPRESSION - A FIELD-TEST OF A POTENTIAL PROTOTYPE

Background: Much attention is being given to developing clinical pract ice guidelines for management of mental health disorders. The aim of t his study was to field test a prototype protocol for the pharmacologic treatment of Major Depression. Method: The protocol consisted of four , six week, treatment phases with critical choices in therapy defined by scores on the MADRS (Montgomery Asberg Depression Rating Scale). Ob servational data as collected on the behaviour of the protocol in term s of relevance, acceptability, ease of use and effectiveness. Results: Effectiveness of the protocol was good for those patients who were re tained within it, with three quarters of them attaining remission. How ever more than half of all patients dropped out-non attendance and adv erse events being the most common reasons for this. Conclusion: The pr otocol for the treatment of Major Depression appeared relevant, easy t o use and potentially effective. Limitation: Problems with non-adheren ce by both doctors and patients posed major challenges to the protocol 's design. Such difficulties demonstrate the need to field test any pr oposed design as preconceptions about a protocol's performance may be misplaced. Clinical Relevance: The protocol tested represents progress towards the goal of developing optimal strategies for the use of phar macotherapeutic agents in the treatment of depression. (C) 1998 Elsevi er Science B.V.