The Texas Medication Algorithm Project: Report of the Texas Consensus Conference Panel on medication treatment of major depressive disorder

Background: This article describes the development of consensus medication algorithms for the treatment of patients with major depressive disorder in the Texas public mental health system. To the best of our knowledge, the Te xas Medication Algorithm Project (TMAP) is the first attempt to develop and prospectively evaluate consensus-based medication algorithms for the treat ment of individuals with severe and persistent mental illnesses. The goals of the algorithm project are to increase the consistency of appropriate tre atment of major depressive disorder and to improve clinical outcomes of pat ients with the disorder. Method: A consensus conference composed of academic clinicians and research ers, practicing clinicians, administrators, consumers, and families was con vened to develop evidence-based consensus algorithms for the pharmacotherap y of major depressive disorder in the Texas mental health system. After a s eries of presentations and panel discussions, the consensus panel met and d rafted the algorithms, Results: The panel consensually agreed on algorithms developed for bath non psychotic and psychotic depression. The algorithms consist of systematic st rategies to define appropriate treatment interventions and tactics to assur e optimal implementation of the strategies, Subsequent to the consensus pro cess, the algorithms were further modified and expanded iteratively to faci litate implementation on a local basis. Conclusion: These algorithms serve as the initial foundation for the develo pment and implementation of medication treatment algorithms for patients tr eated in public mental health systems. Specific issues related to adaptatio n, implementation, feasibility testing, and evaluation of outcomes with the pharmacotherapeutic algorithms will be described in future articles.