Creating an Algorithm
Tracking the spread of diseases can be an intricate, complex, and labor-intensive process. As a result,
automated surveillance systems utilizing algorithms are employed to interpret data. In this segment of
your Scholar-Practitioner Project, you develop a simple algorithm to interpret data related to the disease
or condition you selected last week. To aid your development, review your Learning Resources and
research the construction of algorithms.
To complete this portion of your Scholar-Practitioner Project, write a 1- to 2-page paper that addresses
Identify the indicators you chose to include and explain why they are appropriate.
Describe the logical process of the algorithm (you may wish to illustrate using a diagram).
Justify any other salient features of the algorithm.
Evaluate the strengths and limitations of the algorithm.
Detecting depression from structural MRI scans is significantly new in the mental health
diagnosis. This detection requires processes including image acquisition as well as pre-
processing, feature extraction, selection and classification. Identifying a suitable feature selection
algorithm facilitates the enhancement of the detection accuracy. Medication algorithms for major
depression disorder treatment are designed to optimize treatment implementation and the
correctness of treatment strategies. Therefore, they are significant tools for treatment and
avoidance of refractory depression. Treatment algorithms are express treatment protocols which
CREATING AN ALGORITHM 2
aim at providing specific therapeutic pathways and tools for decision-making throughout the
treatment process (Trivedi & Kleiber, 2001).
Indicators to include in the algorithm and their appropriateness
The severity indicators for a major depressive episode include recurrent thoughts of death
and suicidal ideation, diminished ability to think or concentrate, feelings of worthlessness or
excessive guilt, fatigue or loss of energy, psychomotor agitation or retardation, insomnia or
hypertension, substantial weight loss or weight gain, increased or decreased appetite, diminished
interest or pleasure, and depressed mood. These indicators are appropriate because they provide
a basis for determining the severity of depression. Severity indicators are determined in terms of
the number and type of symptoms exhibited by the patient. Thus, symptoms are either mide,
moderate or severe depending on their degree of impairment of occupational function or the
usual social functions or relationships with other people. The TMAP strongly recommends that
measurement-based care should be adopted in the treatment of major depression disorder. In
addition to symptom severity, it is also important to measure the side effects and global
functioning at each visit in order to ensure that treatment decisions are guided by objective data
(Suehs et al, 2008).
The logical process of the algorithm
The preliminary stage involves the assessment of the patient and discussion of treatment
options. The first step of the algorithm is antidepressant monotherapy. Medication
recommendations for antidepressant monotherapy include selective serotonin reuptake inhibitors,
bupropion and mirtazipine. The selection of treatment is based on individual patient
characteristics. The second step involves augmentation for patients with partial response to
CREATING AN ALGORITHM 3
antidepressant monotherapy. This increases the chances for the achievement of remission
without the loss of clinical improvements. Recommended augmentation strategies include
addition of mirtazipine, buropion,or SSRI (Suehs et al, 2008).
The third step is for patients who do not respond to the first and second step. It involves
the same medications offered in the previous stages, although a different class of antidepressants
should be tried. The fourth step involves combined treatment and it is for patients who do not
respond to medications prescribed in the second stage. The fifth stage is an alternative to the
fourth step, with different combinations of medications. The sixth step is for patients who do not
respond to the previous step. This treatment recommends the use of ECT, or vagus nerve
stimulation in combination with antidepressant treatment. In the seventh stage, there is barely
any evidence to guide treatment. The medications for this stage are based on expert opinion and
the consensus of the TMAP panel (Suehs et al, 2008).
The algorithm requires the individualization of frequency of physician offices visits for
each patient. Generally, an adequate medication trial for antidepressants need to last 8-12 weeks.
Where a patient fails to respond to medication, a switch in antidepressant medication may be
Evaluation of the strengths and limitations of the algorithm
The strength of this treatment algorithm is that it is evidence-based to the extent that
evidence is available for purposes of guiding treatment decisions. In cases of missing clinical
data, treatment recommendations are driven by expert consensus opinion. However, this
algorithm does not serve as a substitute for clinical judgment and it only provides a systematic
approach to pharmacological treatment of major depression disorder (Aronson & Ayres, 2009).
CREATING AN ALGORITHM 4
Aronson, S. C. & Ayres, V. E. (2009). Depression: A Treatment Algorithm for the Family
Physician. Clinical Review Article.
Suehs, B., Argo, T. R., Bendele, S. D. et al. (2008). Texas Medication Algorithm Project
Procedural Manual: Major Depressive Disorder Algorithms. Texas Department of State Health
CREATING AN ALGORITHM 5
Trivedi, M. H., & Kleiber, B. A. (2001). Algorithm for the treatment of chronic depression.
Journal of Clinical Psychiatry.