General Notes

Depression is a common mood disorder. It is characterised by low mood in association with a wide range of emotional, cognitive, physical, and behavioural symptoms. Symptoms of depression may vary in frequency and intensity. The severity of a depressive episode is determined not only by the symptoms experienced, but also by their duration and their impact on function. Newer diagnostic criteria, as recommended by NICE, consider two severity categories: less severe (equating to a PHQ-9 score of less than 16) and more severe (PHQ-9 score of greater than or equal to 16).

Antidepressant medication should not be considered as first-line treatment for less severe depression, unless that is the patient’s preference. Antidepressant medication should be offered along with CBT for more severe depression, where this is practicable. If practicable and acceptable to the patient, CBT or behavioural activation should be considered prior to prescription of antidepressant medication alone

Depression has many associated risks, including the risk of suicide. Any assessment of depression should always include a suicide risk assessment.

Treatment of depressive symptoms of bipolar affective disorder should be as an adjunct to mood stabilisers. Tricyclics and MAOIs should be avoided.

Duration of Treatment:

For a first episode of depression, treatment should be maintained for at least 6 to 9 months after resolution of symptoms.

For patients with 2 or more episodes, treatment should be maintained for at least 2 years, and reviewed at six-monthly intervals thereafter.

Useful links:

NICE Guideline [NG222]: Depression in adults: treatment and management

NHS Choice and Medication: Depression

Advice on switching antidepressants

Well Connected Programme
Lanarkshire's social prescribing programme. Well Connected makes it easy for people to take part in and benefit from activities and services that we know can improve well-being, including anxiety management.

Selective Serotonin Re-Uptake Inhibitors (SSRIs)

Preferred list (P)

SERTRALINE

  • Licensed 18 years and over.

FLUOXETINE

  • Licensed 8 years and over.

 

Total list (T)

CITALOPRAM

  • Caution: Risk of QT-interval prolongation. Concurrent use of citalopram with other medicines known to prolong QT interval is contraindicated.
  • Licensed 18 years and over.

Other Antidepressant Drugs

Total list (T)

VENLAFAXINE

  • Restriction: the modified-release formulation should be reserved for patients intolerant of the standard-release formulation.
  • Risk of discontinuation/withdrawal problems. Please see BNF: VENLAFAXINE - Treatment cessation.
  • Licensed 18 years and over.

MIRTAZAPINE

  • Licensed 18 years and over.

 

Specialist initiation (S1)

VORTIOXETINE

  • Licensed 18 years and over
  • SMC restriction: patients who have experienced an inadequate response (either due to lack of adequate efficacy and/or safety concerns/intolerability) to two or more previous antidepressants.

DULOXETINE

  • Licensed 18 years and over.

 

Tricyclics and Related Antidepressants

Specialist initiation (S1)

TRAZODONE

  • Restriction: Liquid preparation should be reserved for patients with swallowing difficulties.
  • Licensed 18 years and over.

LOFEPRAMINE

  • Lower risk of cardiovascular side-effects in comparison to other tricyclic antidepressants.
  • Licensed 18 years and over.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 04/01/2024

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.