The Texas children's medication algorithm project: Report of the Texas consensus conference panel on medication treatment of childhood major depressive disorder

Objectives: To develop consensus guidelines for medication treatment algori thms for childhood major depressive disorder (MDD) based on scientific evid ence and clinical opinion when science is lacking. The ultimate goal of thi s approach is to synthesize research and clinical experience for the practi tioner and to increase the uniformity of preferred treatment for childhood MDD. A final goal is to develop an approach that can be tested as to whethe r it improves clinical outcomes for children and adolescents with MDD. Meth od: A consensus conference was held. Participants included academic clinici ans and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review and use clinical evidence to recommend sp ecific pharmacological approaches for treatment of MDD in children and adol escents. After a series of presentations of current research evidence and p anel discussion, the consensus panel met, agreed on assumptions, and drafte d the algorithms. The process initially addressed strategies of treatment a nd then tactics to implement the strategies. Results: Consensually agreed-u pon algorithms for major depressions (with and without psychosis) and comor bid attention deficit disorders were developed. Treatment strategies emphas ized the use of selective serotonin reuptake inhibitors. The algorithm cons ists of systematic strategies for treatment interventions and recommended t actics for implementation of the strategies, including medication augmentat ion and medication combinations. Participants recommended prospective evalu ation of the algorithms in various public sector settings, and many volunte ered as sites for such an evaluation. Conclusions: Using scientific and cli nical experience, consensus-derived algorithms for children and adolescents with MDD can be developed.