Lists of Psychopharmacology Algorithms

Updated 30 January, 2004

Compiled by David N. Osser, M.D. and Robert D. Patterson, M.D.

If you know of other algorithms which should be added to this list, please tell us.

Algorithms are arranged by diagnosis, and are listed chronologically by date of publication, starting with the most recent. General references and collections of brief algorithms are in separate lists at the end. Due to the rapidly changing nature of psychopharmacology practice, we have only included algorithms published since 1997.

Algorithm quality varies. For a discussion of how to evaluate the quality of algorithms, see Osser DN, Patterson RD. Psychopharmacology algorithms. In: Shader RI, ed. Manual of psychiatric therapeutics, third edition. Boston, Little, Brown and Company, in press.

Schizophrenia

• Osser DN, Sigadel R. Short-term inpatient pharmacotherapy of schizophrenia. Harvard Rev Psychiatry 2001;9:89-104. Latest update at www.mhc.com/Algorithms
• Buscema CA, Abbasi QA, Barry DJ, Lauve TH. An algorithm for the treatment of schizophrenia in the correctional setting: the forensic algorithm project. J Clin Psychiatry 2000;61(10):767-783. Latest update at www.fap.salu.net
• Expert Consensus Guideline Series: Treatment of schizophrenia. J Clin Psychiatry 1999;60[suppl 11]:3-80.
• Osser DN, Zarate CA Jr. Consultant for the pharmacotherapy of schizophrenia. Psychiatric Annals 1999;29:252-267. Latest update at www.mhc.com/Algorithms
• Miller AL, Chiles JA, Chiles JK, et al. The Texas Medication Algorithm Project (TMAP) schizophrenia algorithms. J Clin Psychiatry 1999;60:649-657. Latest update at www.mhmr.state.tx.us/centraloffice/medicaldirector/TMAP.html
• Working Group for the Canadian Psychiatric Association and the Canadian Alliance for Research on Schizophrenia. Canadian clinical practice guidelines for the treatment of schizophrenia. Can J Psychiatry 1998;43(suppl 2):25-40S.

Depression

• Mulsant BH, Alexopoulos GS, Reynolds, CF, III, et al. Pharmacological treatment of depression in older primary care patients; the PROSPECT algorithm. Int. J. of Geriatric Psychiatry 2001;16:585-592
• Department of Veterans Affairs. The pharmacologic management of major depression in the primary care setting. Veterans Health Administration Publication 00-0016. May, 2000. Find at www.vapbm.org/PBM/treatment.htm
• Crismon ML, Trivedi M, Pigott TA, et al. The Texas Medication Algorithm Project: Report of the Texas consensus conference panel on medication treatment of major depressive disorder. J Clin Psychiatry 1999;60:142-156. Latest update at www.mhmr.state.tx.us/centraloffice/medicaldirector/TMAP.html
• DeBattista C, Solvaason B, Nelson C, Schatzberg AF. Major depression and its subtypes. In: Fawcett J, Stein DJ, Jobson KO, eds. Textbook of treatment algorithms in psychopharmacology. New York: John Wiley & Sons, 1999:38-57.
• Osser DN, Patterson RD. Algorithms for the pharmacotherapy of depression, part one (unipolar, dysthymia), part two (psychotic, treatment-refractory, comorbid). Directions in Psychiatry 1998;18:303-333. Latest update at www.mhc.com/Algorithms
• Schatzburg AF, DeBattista C, Zarate C, Ketter T. The Stanford Algorithm Project - Treatment of Psychotic Major Depression Web site 2002- http://stagehand.stanford.edu/pmd/.

Psychotic Depression

• Bell MA, Rothschild AJ Psychotic Depression: State of the art algorithm improves odds for remission. Current Psychiatry 2004;3:54-63.

Bipolar Depression

• Suppes T. et al. Report of the Texas Consensus Conference Panel on Medication Treatment of Bipolar Disorder 2000. J Clin Psychiatry 2002;63:288-299. Latest update at www.mhmr.state.tx.us/centraloffice/medicaldirector/TIMA.html
• Dantzler A, Osser DN. Algorithms for the pharmacotherapy of acute depression in patients with bipolar disorder. Psychiatric Annals 1999;29:270-284. Latest update at www.mhc.com/Algorithms
• Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP. The expert consensus guideline series: medication treatment of bipolar disorder 2000. Postgrad Med Special Report. 2000(April):1-104.
• Goodwin GM, Bourgeois ML, Conti L, et al. Treatment of bipoplar depressive mood disorders: algorithms for pharmacotherapy. Int J Psychiatry Clin Pract 1997;1:S9-S12.

Bipolar Mania

• Suppes T. et al. Report of the Texas Consensus Conference Panel on Medication Treatment of Bipolar Disorder 2000. J Clin Psychiatry 2002;63:288-299. Latest update at www.mhmr.state.tx.us/centraloffice/medicaldirector/TIMA.html
• Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP. The expert consensus guideline series: medication treatment of bipolar disorder 2000. Postgrad Med Special Report. 2000(April):1-104.
• Bauer MS, Callahan AM, Chowdary J, et al. Clinical practice guidelines for bipolar disorder from the Department of Veterans Affairs. J Clin Psychiatry 1999;60:9-21.
• Post RM, Denicoff KD, Frye MA, Leverich GS. Algorithms for bipolar mania. In: Rush AJ, ed. Mood Disorders: Systematic Medication Management. Basel: Karger, 1997:114-145.
• Kusumaker V, Yatham LN, Haslam DRS, et al. The treatment of bipolar disorder: Review of the literature, guidelines, and options: Treatment of mania, mixed state, and rapid cycling. Can J Psychiatry 1997;42

Panic Disorder

• Goodwin FK, Ghaemi SN. The difficult-to-treat patient with bipolar disorder. In: The difficult to treat psychiatric patient. Dewan MJ, Pies, RW, eds. Washington, D.C., APA Press, 2001:7-39.
• Coplan JD, Gorman JM. Panic Disorder. In: Fawcett J, Stein DJ, Jobson KO, eds. Textbook of treatment algorithms in psychopharmacology. New York: John Wiley & Sons, 1999:88-98.
• Osser DN, Renner JAJr., Bayog R. Algorithms for the pharmacotherapy of anxiety disorders in patients with chemical abuse and dependence. Psychiatric Annals 1999;29(5):285-301. Latest update at www.mhc.com/Algorithms
• Rosenbaum JF, Pollack MH, Friedman SJ. The pharmacotherapy of panic disorder. In: Rosenbaum JF, Pollack MH, eds. Panic Disorder and its Treatment. New York: Marcel Dekker, 1998:153-180.

Posttraumatic Stress Disorder

• Alarcon RD, Glover, S. Boyer W, Balon R. Proposing an algorithm for the pharmacological treatment of posttraumatic stress disorder. Ann Clin Psychiatry 2000;12(4):239-246.
• Expert Consensus Guideline Series Treatment of Posttraumatic Stress Disorder:. J Clin Psychiatry 1999;60(suppl 16):1-76
• Osser DN, Renner JAJr., Bayog R. Algorithms for the pharmacotherapy of anxiety disorders in patients with chemical abuse and dependence. Psychiatric Annals 1999;29(5):285-301. Latest update at www.mhc.com/Algorithms

Social Anxiety Disorder (Social Phobia)

• Stein DJ, Kasper S, Matsunaga H, Osser DN, Stein MB, van Ameringen M, Versiana M, Westenberg H, Zhang M. Pharmacotherapy of social anxiety disorder: an algorithm for primary care - 2001. Primary Care Psychiatry 2001;7(3):107-110.
• Sutherland SM, Davidson JRT. Social phobia. In: Fawcett J, Stein DJ, Jobson KO, eds. Textbook of treatment algorithms in psychopharmacology. New York: John Wiley & Sons, 1999:107-118.
• Osser DN, Renner JAJr., Bayog R. Algorithms for the pharmacotherapy of anxiety disorders in patients with chemical abuse and dependence. Psychiatric Annals 1999;29(5):285-301. Latest update at www.mhc.com/Algorithms
• Marshall RD, Schneier FR. An algorithm for the pharmacotherapy of social phobia. Psychiatric Annals 1996;26(4):210-216.

Obsessive-Compulsive Disorder

• Greist JH, Jefferson JW. Pharmacotherapy for obsessive-compulsive disorder. Br J Psychiatry 1998;173(suppl 35):64-70.
• Francis A, Docherty JP, Kahn DA. Treatment of obsessive-compulsive disorder: the expert consensus guideline series. J Clin Psychiatry 1997;58[suppl 4]:11-27.

Generalized Anxiety Disorder

Osser DN, Renner JAJr., Bayog R. Algorithms for the pharmacotherapy of anxiety disorders in patients with chemical abuse and dependence. Psychiatric Annals 1999;29(5):285-301. Latest update at www.mhc.com/Algorithms

Body Dysmorphic Disorder

Phillips KA. Pharmacotherapy of body dysmorphic disorder: a review of impirical evidence and a proposed treatment algorithm. Psychiatric Clinics of North America Annals of Drug Therapy 2000;7:59-82.

Agitation in the Patient with Dementia

• Kahn DA, Alexopoulos GS, Silver JM, et al. Treatment of agitation in elderly persons with dementia: a summary of the expert consensus guidelines. Journal of Practical Psychiatry and Behavioral Health 1998;4(5):265-276.
• Colenda CC. Managing agitated dementia patients: a decision analysis approach. J Pract Psychiatry Behav Health 1997;3:156-164.

Personality Disorders

• American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry 2001;158(10)Supplement, pp 45-46.
• Soloff PH. Psychopharmacology of borderline personality disorder. Psychiatr Clinics North Am 2000;23(1):169-192.
• Soloff PH. Algorithms for pharmacological treatment of personality dimensions: Symptom-specific treatment for cognitive-perceptual, affective, and impulsive-behavioral dysregulation. Bulletin of the Menninger Clinic 1998;62(2):195-214.

Attention Deficit Hyperactivity Disorder in Adults

Bhandary AN, Fernandez F, Gregory RJ, et al. Pharmacotherapy in adults with ADHD. Psychiatric Annals 1997;27(8):545-555.

Tobacco Dependence

The Tobacco Use and Dependence Clinical Practice Guideline Panel. A clinical practice guideline for treating tobacco use and dependence: A US public health service report. JAMA 2000;283(24):3244-3254.

Child and Adolescent Psychopharmacology

• Subcommittee on ADHD, American Academy of Pediatrics. Clinical practice guideline: treatment of the school-aged child with ADHD. Pediatrics 2001;108(4 October):1033-1044.
• Emslie GJ, Mayes TL, Hughes CW. Updates in the pharmacologic treatment of childhood depression. Psychiatr Clin North Am Annual of Drug Therapy 2000;7:235-256.
• Martin A, Kaufman J, Charney D. Pharmacotherapy of early-onset depression: update and new directions. Child and Adol Psychiatr Clin North Am 2000;9(1):135-157.
• Pliszka SR, Greenhill LL, Crismon ML et al. The Texas children’s medication algorithm project: report of the Texas consensus conference panel on medication treatment of childhood attention-deficit/hyperactivity disorder, part I. Part II: Tactics. J Am Acad Child Adolesc Psychiatry 2000;39(7):908-927. Latest update at http://www.mhmr.state.tx.us/centraloffice/medicaldirector/cmap.html
• Davanzo PA. Mood stabilizers in the treatment of juvenile bipolar disorder: advances and controversies. Child Adol Psychiatr Clin North Am 2000;9(1):159-182.
• Birmaher B, Brent D, Heydl P. Childhood-onset depressive disorders. In: Fawcett J, Stein DJ, Jobson KO, eds. Textbook of treatment algorithms in psychopharmacology. New York: John Wiley & Sons, 1999:135-163.
• Hughes, C.W., Emslie, G.J., Crismon, M.L., Wagner, K.D., Birmaher, B., Geller, B., Pliszka, S., Ryan, N., Stober, M., Trivedi, M.H., Toprac, M.G., Sedillo, A., Llana, M.E., Lopez, M., Rush, A.J. and the Texas Consensus Conference Panel on medication treatment of childhood major depressive disorder. The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on medication treatment of childhood major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38:1442-1454, 1999. Latest update at http://www.mhmr.state.tx.us/centraloffice/medicaldirector/cmap.html

Developmental Disabilities: Behavioral Disorders

Mikkelsen EJ, McKenna L. Psychopharmacologic algorithms for adults with developmental disabilities and difficult-to-diagnose behavioral disorders. Psychiatric Ann 1999;29(5):302-314.

General Articles on the Theory and Practice of Constructing Algorithms

• Trivedi M, Rush AJ, Crismon ML, et al. Treatment guidelines and algorithms. Psychiatr Clin North Am Annual of Drug Therapy 2000;7:1-22.
• Patterson RD. The Harvard psychopharmacology algorithm project. Psychiatric Ann 1999;29(5):248-250.
• Hartley DS III. The language of algorithms. In: Fawcett J, Stein DJ, Jobson KO, eds. Textbook of treatment algorithms in psychopharmacology. New York: John Wiley & Sons, 1999:15-31.
• Gilbert DA, Altshuler KZ, Rago WV, et al. Texas medication algorithm project: Definitions, rationale, and methods to develop medication algorithms. J Clin Psychiatry 1998;59:345-51.
• Jobson KO. International Psychopharmacology Algorithm Project: Algorithms in psychopharmacology. Int J Psychiatry Clin Pract 1997;1:S3-S8.
• Colenda CC. Managing agitated dementia patients: a decision analysis approach. J Pract Psychiatry Behav Health 1997;3:156-164.

Testosterone Treatment in Psychiatry

• Smith MJ Testosterone treatment algorithms in psychiatry. Psych Annals 2003;33(8):511-516.

Other References of Interest on Algorithms/Guidelines

• Janicak PG, Davis JM, Preskorn SH, Ayd FJ Jr. Principles and Practice of Psychopharmacotherapy, 3^d edition. Philadelphia: Williams & Wilkins, 2001. Textbook with algorithm-like “strategies” throughout the text.
• Waddell C. So much research evidence, so little dissemination and uptake. Evidence-Based Mental Health 2001;4:3-5.
• Stein DJ, Seedat S, Niehaus D, Pienaar W, Elmsley R. Psychiatric algorithms for primary care, part I and part II. Primary Psychiatry 2000;7(2):45-69, and 2000;7(3):35-68. Collection of algorithms that addresses many clinical problems seen by primary care physicians. The algorithms are being updated annually.
• Geyman JP, Deyo RA, Ramsey SD. Evidence-based clinical practice: concepts and approaches. Boston, MA: Butterworth-Heinemann, 2000.
• Shore MF. Algorithms and the quality of care. Psychiatric Ann 1999;29(5):315-316.
• Taylor D, McConnell D, McConnell H, Able K, Kerwin R. The Bethlem & Maudsley NHS Trust Prescribing Guidelines. 5th Edition. Martin Dunitz. Cambridge, England. 1999. Excellent guidelines and algorithms for psychiatry house staff in the British Isles, vigorously taught by attending psychiatrists. Does not have evidence citations, but the approaches are clearly solidly evidence-based. Updated frequently.
• Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282:1458-1465.
• Rush AJ, Crismon ML, Toprac MG et al. Implementing guidelines and systems of care: experiences with the Texas Medication Algorithm Project (TMAP). J Pract Psychiatry Behav Health 1999;5:75-86.
• Montgomery SA. Algorithms – a European perspective. In: Fawcett J, Stein DJ, Jobson KO, eds. Textbook of treatment algorithms in psychopharmacology. New York: John Wiley & Sons, 1999:1-6.
• Trivedi MH, DeBattista C, Fawcett L, Nelson JC, Osser DN, Stein DJ, Jobson KO. Developing treatment algorithms for unipolar depression in cyberspace: International Psychopharmacology Algorithm Project. Psychopharmacology Bull 1998;34:355-359.
• Sato M, Higuchi T, Yamawaki S. Proposals for the rational selection of drugs in the treatment of schizophrenia and mood disorders [in Japan]. Psychiatry Clin Neurosci 1999(October);53(Suppl.):S1-S82. Proceedings of International Meeting on Japan Psychopharmacology Algorithms.
• Fawcett J, Stein DJ, Jobson K (eds); Textbook of treatment algorithms in psychopharmacology. Wiley & Sons, New York 1999