The Texas Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Major Depressive Disorder
Abstract
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 Texas Medication Algorithm Project (TMAP) is the first attempt to develop and prospectively evaluate consensus-based medication algorithms for the treatment of individuals with severe and persistent mental illnesses. The goals of the algorithm project are to increase the consistency of appropriate treatment of major depressive disorder and to improve clinical outcomes of patients with the disorder. Method A consensus conference composed of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families was convened to develop evidence-based consensus algorithms for the pharmacotherapy of major depressive disorder in the Texas mental health system. After a series of presentations and panel discussions, the consensus panel met and drafted the algorithms. Results The panel consensually agreed on algorithms developed for both nonpsychotic and psychotic depression. The algorithms consist of systematic strategies to define appropriate treatment interventions and tactics to assure optimal implementation of the strategies. Subsequent to the consensus process, the algorithms were further modified and expanded iteratively to facilitate implementation on a local basis. Conclusion These algorithms serve as the initial foundation for t…
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1990s expert consensus guidelines, such as the Texas Medication Algorithm Project, recommended adding a second agent for partial responders and switching antidepressants for nonresponders.
“Expert consensus guidelines developed in the 1990s, such as the Texas Medication Algorithm Project, 2 recommended augmentation with a second agent for partial responders and switching to a new antidepressant for nonresponders.”
From Antidepressant augmentation: Good news, limitations, and stumbling blocks (2015) · cites this paper as [2]
According to expert consensus, partial responders to an initial antidepressant are the target population for augmentation studies.
“which, according to expert consensus, should be the target population for augmentation studies.”
From Antidepressant augmentation: Good news, limitations, and stumbling blocks (2015) · cites this paper as [2]
Those 1990s recommendations rested on expert consensus rather than empirical evidence.
“Importantly, these recommendations were based on expert consensus and not on empirical evidence.”
From Antidepressant augmentation: Good news, limitations, and stumbling blocks (2015) · cites this paper as [2]
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Kocsis, J. H. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.144 · Cited by 214 · see citing works
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. Comparison of self-report and clinician ratings on two inventories of depressive symptomatology.
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Self-citationTachyphylaxis in major depressive disorder: A review of the current state of research
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MethodConsiderations in the management of the patient with comorbid depression and anxiety
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Antidepressant augmentation: Good news, limitations, and stumbling blocks
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Dalrymple, K. L., Wahrer, K. S., Walsh, E., Rosenstein, L., & Zimmerman, M. (2023) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2022-0014 · Cited by 1 · see citing works
- Authors
- Crismon, M. L., Trivedi, M., Pigott, T. A., Rush, A. J., Hirschfeld, R. M. A., Kahn, D. A., DeBattista, C., Nelson, J. C., Nierenberg, A. A., Sackeim, H. A., Thase, M. E., & Disorder, T. T. C. C. P. O. M. T. O. M. D.
- Affiliations
- The University of Texas at Austin (US)
- The University of Texas Southwestern Medical Center (US)
- The University of Texas Medical Branch at Galveston (US)
- Columbia University (US)
- Stanford University (US)
- Yale University (US)
- Harvard University (US)
- University of Pittsburgh (US)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 1999-03-15
- Volume
- 60
- Issue
- 3
- Pages
- 142-156
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1972524498
- Cited by
- 250
- References
- 0
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 7 · 2021: 8 · 2020: 6 · 2019: 7 · 2018: 8 · 2017: 2 · 2016: 10 · 2015: 8 · 2014: 6 · 2013: 4 · 2012: 10
- FWCI
- 7.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R24MH053799)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- medication algorithm, major depressive disorder, consensus conference, pharmacotherapy, public mental health system, psychotic depression, non-psychotic depression, treatment consistency, algorithm implementation
- MeSH terms
- Algorithms, Antidepressive Agents, Community Mental Health Services, Decision Trees, Depressive Disorder, Humans, Texas, Antipsychotic Agents, Drug Costs, Economics, Pharmaceutical
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