| Indications for using antidepressants are: an incomplete response to psychotherapy alone, patient request, chronic symptoms (two years or more), previous episodes of depression, a family history of depression, and previous response to antidepressants. |
| | Most patients do best with a combination of antidepressants and some form of psychological therapy.
|
| | A 4-6 week trial of an antidepressant is reasonable before trying a drug from another class of antidepressant.
|
| | Patients who respond to drug therapy should continue with the same dose for 4-9 months to prevent a relapse.
|
| | Consider maintenance therapy (ie, continuing treatment for two or more years) for those who have had three previous episodes of depression, those with two previous episodes (if such episodes were recent and severe), and those with a family history of bipolar disorder or recurrent depression.
|
| Recommended order of antidepressant use in general practice:
|
| | First line: Selective serotonin reuptake inhibitors (SSRIs), venlafaxine, nefazodone, moclobemide or mianserin.
Second line: Tricyclic antidepressants (desipramine or nortriptyline are preferred as they have fewer anticholinergic effects and are less sedating).
Third line: Irreversible monoamine oxidase inhibitors (MAOIs).
|
