Table 2_Algorithm-guided treatment for major depressive disorder versus treatment as usual: a systematic review.docx

IntroductionA substantial proportion of patients with major depressive disorder do not remit after the initial pharmacological treatment, and a major obstacle is that progression to subsequent treatment steps often occurs too slowly, highlighting the need for more structured and effective therapeutic strategies. Algorithm-guided treatments (AGTs) provide a systematic, stepwise framework for clinical decision-making, potentially improving acute treatment outcomes compared to treatment as usual (TAU).
MethodsThis systematic review, conducted according to PRISMA 2020 guidelines, evaluated randomized controlled trials (RCTs) comparing AGTs to TAU in adult patients with major depressive disorder. Databases searched included PubMed, Scopus, Embase, PsychInfo, and the Cochrane Library up to June 2025. Trials investigating adults diagnosed with major depressive disorder, utilizing clinician-rated depression scales, and with a trial duration of four weeks or more were included.
ResultsSeven RCTs met the criteria, encompassing over 3,500 participants. Most studies demonstrated superior outcomes in participants allocated to AGT compared to TAU, including significantly shorter time to remission, a higher proportion of patients achieving remission and response, as well as better adherence to treatment protocols. Some studies found marginal or nonsignificant differences between interventions in some of the outcomes, particularly those involving comorbid populations.
DiscussionThese findings suggest that implementing structured, algorithm-based treatment strategies can improve the quality and efficacy of care for patients diagnosed with major depressive disorder, supporting their wider integration into clinical practice.

引言
重度抑郁症（major depressive disorder）患者中，有相当比例在初始药物治疗后未能达到临床缓解，而主要障碍在于后续治疗步骤的推进往往过于迟缓，这凸显了开发更结构化、更有效的治疗策略的必要性。算法引导治疗（Algorithm-guided treatments, AGTs）可为临床决策提供系统化的阶梯式框架，相较于常规治疗（treatment as usual, TAU），或可改善急性期治疗结局。

方法
本研究依据PRISMA 2020指南开展系统综述，旨在评估对比算法引导治疗与常规治疗在成年重度抑郁症患者中应用效果的随机对照试验（randomized controlled trials, RCTs）。检索数据库截至2025年6月，涵盖PubMed、Scopus、Embase、PsychInfo及Cochrane图书馆。纳入试验需满足以下条件：研究对象为确诊重度抑郁症的成年患者、采用临床医师评定的抑郁量表、试验时长不少于4周。

结果
共有7项随机对照试验符合纳入标准，涵盖超过3500名受试者。多数研究显示，相较于常规治疗组，分配至算法引导治疗组的受试者获得了更优的结局指标，包括显著更短的临床缓解时间、更高的临床缓解率与应答率，以及更佳的治疗方案依从性。部分研究则发现，两种干预措施在部分结局指标上仅存在微小差异或无统计学显著性，尤其在共病人群相关研究中这一现象更为突出。

讨论
本研究结果表明，实施结构化的算法导向治疗策略，可提升重度抑郁症患者的照护质量与临床疗效，有助于推动该类疗法在临床实践中的更广泛应用。