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Table 1 Treatment decision points and adjustments

From: Optimization of measurement-based care (OMBC) for depression based on all-round and continuous assessment: rationale and protocol for a multicenter randomized control clinical trial

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.
  1. QIDS-SR 16 16-item Quick Inventory of Depressive Symptomatology–Self-Report, FIBSER Frequency, Intensity, and Burden of Side Effects Rating Scale, CCBT computerized cognitive behavioral therapy