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Tijdschrift voor Psychiatrie 53 (2011) 4, 223 - 233

Review article

The algorithm for the biological treatment of depression in the Dutch multidisciplinary guideline on depression

J. Spijker, W.A. Nolen

background Although antidepressants are effective in the treatment of depression, nonresponse is unfortunately a recurring problem. Treatment algorithms can help the health care professional to make consecutive step-by-step choices between the different available treatment options.
aim To update the biological algorithm in the Dutch multidisciplinary guideline on the treatment of depression. method The literature was reviewed systematically.
results There are five steps in the algorithm: 1. Treatment starts with an ssri, a tca, an snri, mirtazapine or buproprion. 2. If there is no response after 4-10 weeks, administer another antidepressant. 3. Augment medication with lithium. 4. Administer a monoamine oxidase inhibitor. 5. Apply electroconvulsive therapy.
conclusion The algorithm is certainly worth using, but its efficacy needs to be fully investigated.s 

keywords antidepressants, guideline, major depressive disorder, treatment algorithm