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.