Texas Medication Algorithm Project

The Texas Medication Algorithm Project (TMAP) is a decision-tree medical algorithm, the design of which was based on the expert opinions of mental health specialists. It has provided and rolled out a set of psychiatric management guidelines for doctors treating certain mental disorders within Texas' publicly-funded mental health care system, along with manuals relating to each of them. The algorithms commence after diagnosis and cover pharmacological treatment (hence "Medication Algorithm").

History
TMAP was initiated in the fall of 1997 and the initial research covered around 500 patients.

TMAP arose from a collaboration that began in 1995 between the Texas Department of Mental Health and Mental Retardation (TDMHMR), pharmaceutical companies, and the University of Texas Southwestern. The research was supported by the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Meadows Foundation, the Lightner-Sams Foundation, the Nanny Hogan Boyd Charitable Trust, TDMHMR, the Center for Mental Health Services, the Department of Veterans Affairs, the Health Services Research and Development Research Career Scientist Award, the United States Pharmacopoeia Convention Inc. and Mental Health Connections.

The companies that produce and market the drugs(1) recommended as standard treatments furnished some unrestricted funding for the project but did not participate in the production of the guidelines.

In 2004 TMAP was mentioned as an example of a successful project in a paper regarding implementing mental health screening programs throughout the United States, by the President George W. Bush's   New Freedom Commission on Mental Health, which looks to expand the program federally. The President had previously been Governor of Texas, in the period when TMAP was implemented. Similar programs have been implemented in about a dozen States, according to a 2004 report in the British Medical Journal.

Similar algorithms and prescribing advice have been produced elsewhere, for instance at the Maudsley Hospital, London.

TMAP's sponsors produce the pharmaceuticals recommended as "first line treatment" -- Prozac, Risperdal, Adderall, Zyprexa, Seroquel, Buspar, Geodon, Depakote, Effexor, Paxil, Celexa, Zoloft, Wellbutrin, Serzone and Remeron. TMAP's financial ties with pharmaceutical companies are extensive, including:


 * $2.4 million for the initial creation of TMAP from the Robert Wood Johnson Foundation, which was set up by the estate of a former Johnson & Johnson chief executive. Johnson & Johnson is the parent company of Janssen Pharmaceuticals (the makers of Risperdal).
 * $191,183 from Janssen itself.
 * $146,500 from Pfizer (Zoloft and Geodon).
 * $103,000 from Eli Lilly (Prozac and Zyprexa).
 * Additional funds from Astrazeneca, Novartis, Janssen-Ortho-McNeil, GlaxoSmithKline, Abbott, Bristol Myers Squibb, Wyeth-Ayerst Forrest Laboratories and U.S. Pharmacopeia.

Footnote
1. Risperdal, Zyprexa, Seroquel, Geodon, Depakote, Paxil, Zoloft, Celexa, Wellbutrin, Zyban, Remeron, Serzone, Effexor, Buspar, Adderall and Prozac.

Texas Medication Algorithm Project