1. Effectiveness evaluation of mood disorder treatment algorithms in Brazilian public healthcare patients
- Author
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Flávio Shansis, Carisi Anne Polanczyk, Sandro René Pinto de Sousa Miguel, Jacques J. Zimmermann, Ana Flávia Barros da Silva Lima, Luciane Nascimento Cruz, Marcelo Pio de Almeida Fleck, Patricia Klarmann Ziegelmann, and Mírian Cohen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Bipolar Disorder ,National Health Programs ,lcsh:RC435-571 ,unipolar ,MEDLINE ,Agentes antipsicóticos ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Surveys and Questionnaires ,lcsh:Psychiatry ,Epidemiology ,medicine ,Humans ,Transtorno depressivo maior ,Bipolar disorder ,Transtornos do humor ,Depressive Disorder, Major ,economic issues ,clinical drug studies ,business.industry ,Brasil ,Transtorno bipolar ,medicine.disease ,Programas nacionais de saúde ,bipolar ,030227 psychiatry ,Clinical trial ,Psychiatry and Mental health ,Treatment Outcome ,Mood ,Socioeconomic Factors ,Mood disorders ,Major depressive disorder ,Female ,Original Article ,epidemiology ,business ,Algorithm ,Algorithms ,Brazil ,030217 neurology & neurosurgery ,Antipsychotic Agents - Abstract
Objective To assess the effectiveness of three mood disorder treatment algorithms in a sample of patients seeking care in the Brazilian public healthcare system. Methods A randomized pragmatic trial was conducted with an algorithm developed for treating episodes of major depressive disorder (MDD), bipolar depressive episodes and mixed episodes of bipolar disorder (BD). Results The sample consisted of 259 subjects diagnosed with BD or MDD (DSM-IV-TR). After the onset of symptoms, the first treatment occurred ∼6 years and the use of mood stabilizers began ∼12 years. All proposed algorithms were effective, with response rates around 80%. The majority of the subjects took 20 weeks to obtain a therapeutic response. Conclusions The algorithms were effective with the medications available through the Brazilian Unified Health System. Because therapeutic response was achieved in most subjects by 20 weeks, a follow-up period longer than 12 weeks may be required to confirm adequate response to treatment. Remission of symptoms is still the main desired outcome. Subjects who achieved remission recovered more rapidly and remained more stable over time. Clinical trial registration NCT02901249, NCT02870283, NCT02918097.
- Published
- 2017