Table 1 Treatment decision points and adjustments
Time | Assessment tool | Score | Escitalopram | Duloxetine |
|---|---|---|---|---|
Baseline | Initial dose 10 mg/day; if the patient cannot tolerate, can reduce the dose. | Initial dose 60 mg/day; if the patient cannot tolerate, can reduce the dose. | ||
Week 2 | QIDS-SR 16 ≤ 5 | Remission | Maintain current dose. | Maintain current dose. |
QIDS-SR 16 = 6–8 | Partial response | Maintain the current dose or increase it to 15 mg/day | Maintain the current dose or increase it to 80/90 mg/day. | |
Side effects cannot tolerate (item 3 of FIBSER = 5–6) | Maintain the current dose and symptomatic treatment of side effects/reduction of one dose unit. | Maintain the current dose and symptomatic treatment of side effects/reduction of one dose unit. | ||
QIDS-SR 16 ≥ 9 | Treatment failure | Increase at least one dose unit or the drug has reached the highest dose to maintain the current dose. | Increase at least one dose unit or the drug has reached the highest dose to maintain the current dose. | |
Side effects cannot tolerate (item 3 of FIBSER = 5–6) | Reduce a dose unit or switch to duloxetine. | Reduce a dose unit or switch to escitalopram. | ||
Week 4 | QIDS-SR 16 ≤ 5 | Remission | Maintain current dose. | Maintain current dose. |
QIDS-SR 16 = 6–8 | Partial response | Maintain the current dose or increase it to 20 mg/day. | Maintain the current dose or increase it to 120 mg/day. | |
Side effects cannot tolerate (item 3 of FIBSER = 5–6) | Maintain the current dose and symptomatic treatment of side effects/reduction of one dose unit. | Maintain the current dose and symptomatic treatment of side effects/reduction of one dose unit. | ||
QIDS-SR 16 ≥ 9 | Treatment failure | Patients who have been added to the highest dose and have completed 2 weeks may choose to change their medicine; if the maximum dose treatment is less than 2 weeks, maintain the current dose; for the dosage not reaching the maximum dose, increase it to 20 mg/day. | Patients who have been added to the highest dose and have completed 2 weeks may choose to change their medicine; if the maximum dose treatment is less than 2 weeks, maintain the current dose; for the dosage not reaching the maximum dose, increase it to 60 mg/day. | |
Side effects cannot tolerate (item 3 of FIBSER = 5–6) | Reduce a dose unit or switch to duloxetine. | Reduce a dose unit or switch to escitalopram. | ||
Weeks 6, 8, and 10 | QIDS-SR 16 ≤ 5 | Remission | Maintain current dose. | Maintain current dose. |
QIDS-SR 16 = 6–8 | Partial response | Maintain the current dose or increase it to 20 mg/day. | Maintain the current dose or increase it to 120 mg/day. | |
Side effects cannot tolerate (item 3 of FIBSER = 5–6) | Maintain the current dose and symptomatic treatment of side effects reduction of one dose unit. | Maintain the current dose and symptomatic treatment of side effects/reduction of one dose unit. | ||
QIDS-SR 16 ≥ 9 | Treatment failure | The drug has been added to the highest dose to maintain the current dose; for the dosage not reaching the maximum dose, increase it to 20 mg/day. | The drug has been added to the highest dose to maintain the current dose; for the dosage not reaching the maximum dose, increase it to 120 mg/day. | |
Side effects cannot tolerate (item 3 of FIBSER = 5–6) | Lower a dose unit or change the medicine. | Lower a dose unit or change the medicine. | ||
Week 12 | QIDS-SR 16 ≤ 5 | Remission | Into the maintenance phase, randomized. | A. Comprehensive intervention group: maintenance drug treatment for 6 months and CCBT. |
B. Drug treatment group: maintenance drug treatment for at least 6 months. | ||||