A Computer Algorithm for Calculating the Adequacy of Antidepressant Treatment in Unipolar and Bipolar Depression
J Clin Psychiatry 2003;64(7):825-833
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: Major depression is often treated
with medications in doses that are too low or too short in
duration. We published an early version of the Antidepressant
Treatment History Form (ATHF) that rates the adequacy of
antidepressant treatment. The updated ATHF presented here
includes newer medications and a computer algorithm to automate
the evaluation of the adequacy of pharmacotherapy or
electroconvulsive therapy for depression.
Method: The computer algorithm was written in
MS-DOS Q-BASIC and in Visual Basic 5.0. Treatment data from 47
depressed (Structured Clinical Interview for DSM-III-R) patients
were scored by the computer algorithm and assigned a number from
0 to 5 for the adequacy of antidepressant treatment. A
psychiatrist blinded to the computer ratings manually rated the
treatment using the ATHF.
Results: The computer algorithm, based on an
updated version of the ATHF, estimates the adequacy of treatment
of unipolar and bipolar depression. Computer algorithm results
agreed with those generated by a clinician completing the form
manually (kappa = 0.88 to 1.00).
Conclusion: The computer algorithm can be used
to analyze large databases and may help reduce the morbidity and
mortality associated with major depression by improving the
assessment of adequacy of pharmacologic treatments for research
and quality assurance purposes. The availability of the updated
ATHF on the Internet for downloading allows for modifications
according to the user's purposes.