IMPROVEMENT after 4-6 weeks (assuming adequately dosed and adherent) using the PHQ-9 PHQ-9 drop from Improvement Antidepressant Plan Psychotherapy Plan* baseline 5 points Adequate Continue current dose No change ≥ Consider Dose vs Augment** Consider adding  Probably OR 2-4 points antidepressant if not already Inadequate taking Switch if not tolerating Strongly consider Dose vs Augment** antidepressant if not already  taking 1 point or increase Inadequate OR Contact therapist re: PHQ-9 Switch if not tolerating score *Reasonable time to improvement may vary depending on the type of psychotherapy **Augment is defined as adding an additional agent to the regimen Potential reasons for inadequate improvement: Inaccurate diagnosis Nonadherence to treatment Unaddressed co-occurring medical, psychiatric or substance use disorders Inadequate dose of medication or frequency of therapy Inadequate duration of treatment Pharmacokinetic/pharmacodynamic factors affecting medication action
IMPROVEMENT after 4-6 weeks (assuming adequately dosed and adherent) using the PHQ-9 PHQ-9 drop from baseline Improvement Antidepressant Plan Psychotherapy Plan* ≥ 5 points Adequate Continue current dose No change 2-4 points Probably Inadequate Consider  Dose vs Augment** OR Switch if not tolerating Consider adding antidepressant if not already taking 1 point or increase Inadequate  Dose vs Augment** OR Switch if not tolerating Strongly consider antidepressant if not already taking Contact therapist re: PHQ-9 score *Reasonable time to improvement may vary depending on the type of psychotherapy **Augment is defined as adding an additional agent to the regimen Potential reasons for inadequate improvement: Inaccurate diagnosis Nonadherence to treatment Unaddressed co-occurring medical, psychiatric or substance use disorders Inadequate dose of medication or frequency of therapy Inadequate duration of treatment Pharmacokinetic/pharmacodynamic factors affecting medication action
BHICCI-Major-Depression-Final.docx