The Texas Medication Algorithm Project is one of the first large-scale effectiveness studies to evaluate medication algorithms used for treating major psychiatric disorders. In his opening remarks, Dr. Trivedi stated that the two principal goals of the Texas Medication Algorithm Project were
(1) to increase the number of patients recovering from major depressive disorder and
(2) to provide treatment guidelines that result in earlier remission.

The Texas Medication Algorithm is a 7-step algorithm that starts with simple monotherapy and moves to more complex interventions.
Patients are moved from one stage to another depending on their response to treatment.
The algorithm was designed to provide multiple treatment options for physicians, flexibility for patient preferences, and uniform documentation of outcomes.

Dr. Trivedi conducted a study to demonstrate the use of the Texas Medication Algorithm. In this study, Dr. Trivedi assigned 548 outpatients with major depressive disorder to one of three treatment groups: patient/family education package (n=182); treatment as usual using no algorithm (n=154); and treatment as usual using an algorithm for another disorder (n=212).
Of the sample total, 73% provided 12 months of follow-up data. Primary outcomes included quarterly patient and physician symptom and function ratings. Symptom ratings were obtained using the 30-item Inventory of Depressive Symptomatology.
Function ratings used the mental component of the Medical Outcomes Study 12-item Short-Form. Participating physicians were supported with resources, continuing medical education on algorithms, and clinical help implementing the algorithm.

Dr. Trivedi reported that while the patient sample overall showed significant improvement during the study, patients assigned to the patient/family education package showed two-fold greater symptom reduction than the matched treatment-as-usual group.
Compared with the treatment-as-usual group, patients assigned to the patient/family education package also showed significantly greater reduction in self-reported depressive symptoms and better improvement in the Medical Outcomes Study 12-item Short-Form. These results were evident in the first 3 months of the study and were maintained for the following 9 months.

Dr. Trivedi concluded by encouraging clinicians to use this algorithm and to learn more about it at the Texas Medication Algorithm Project website ("http:www.mhmr.state.tx.us/centraloffice/medicaldirector/tmap.html").