A Decision-Support System to Personalize Antidepressant Treatment in Major Depressive Disorder

作者：Andrea Cipriani, Karen Barros Parron Fernandes, Benoit H. Mulsant, Orestis Efthimiou, Nicola Williams, Sam Mort, Rania Elgarf, Qiang Liu, Nyla Haque, J. Manning Potts, Roger Ede, Robin Lane Fox, Marcos Liboni, Diego A. Nesi Cavicchioli, Judit Simon, Katharine Smith, Caroline Zangani, Zhenpeng Li, Ursula Taylor, M. Ishrat Husain, Maddalena Cipriani, Paulo V. Carpaneze Dalaqua, Eduardo Fernandes Leite, Gustavo Aliano Gâmbaro, Diogo Nabhan Silveira, Luísa Manfredin Vila, Fernanda Liboni Cavicchioli, Toshi A. Furukawa, Huseyin Naci, Edoardo G. Ostinelli, PETRUSHKA Team, Arradea Triesty Adinda, Nadeem Ahmed, Rosario Aronica, Eduarda Batista, Jithen Benjamin, Ian Binnian, Ruth Carson, Helen Collins, Johanna Cook, Rachel Delahay, Franco De Crescenzo, Lazarina Engonidou, Simon Gilbody, James S. W. Hong, Owen Hughes, Matt Jaquiery, Benjamin Johnston, Gemma Lewis, Andrea Paggi, Nicola Rizzopesci, Pippa Sealy, Neetul Shah, Rachel Shaw, Ilina Singh, Katherine Stevens, Jaimini Tanna, Anneka Tomlinson, Laurence Wainwright, Nick Wooding, Ly-Mee Yu, Stefan Kloiber, Daniel Mueller, Helena K. Kim, Brett D. M. Jones, Abigail Ortiz, Daniel Blumberger, Georgia Salanti, Stéphanie P. Araújo, Paulo R. Bignardi, Bruna G. Camargo, Andréa N. Colado Simões, João Pedro de Vasconcelos, Bianca B. P. Fernandes, Isadora L. Gobbi, Rafael S. A. Haber, Renato C. Jacovetti, Augusto Borges Liboni, Caio C. S. Martins, Amanda P. Oliveira, Giulia G. A. Ramos, Carolina B. N. Rodrigues, Raul H. M. Santos, Letícia F. R. Silva, Gabriela G. Tassi, Vitor F. Tomazini · 发表于：JAMA · 年份：2026 · DOI：10.1001/jama.2026.1327 · 被引用次数：7 · 研究领域：Digital Mental Health Interventions、Treatment of Major Depression、Mental Health via Writing

Importance: Antidepressants for moderate to severe major depressive disorder may be discontinued prematurely because the prescribed antidepressant is not always the most appropriate medication for an individual. Guidelines have recommended more precise targeting of antidepressant treatment. Objective: To evaluate the efficacy of a web-based tool to personalize antidepressant treatment. Design, Setting, and Participants: This multicenter, randomized clinical trial included persons between the ages of 18 and 74 years with major depressive disorder. The trial was conducted at 47 sites in 3 countries (Brazil, Canada, and the UK). The first participant was screened on November 29, 2022, and the last follow-up visit occurred on January 15, 2025. Intervention: A total of 540 participants were randomized (1:1) to an evidence-based clinical decision-support system (PETRUSHKA tool; n = 271) or usual care (n = 269). Main Outcomes and Measures: The primary outcome was treatment discontinuation due to any cause at 8 weeks. The secondary outcomes included treatment discontinuation up to 24 weeks due to adverse events and changes in depressive symptoms (measured with the 9-item Patient Health Questionnaire [PHQ-9]; range, 0-27; higher scores indicate more severe depression) and anxiety symptoms (measured with the 7-item Generalized Anxiety Disorder [GAD-7] questionnaire; range, 0-21; higher scores indicate more severe symptoms). Results: Of the 520 eligible participants, 493 were included i...