- For guidance on the non-pharmaceutical management of depression refer to SIGN 114.
- Refer to antidepressant guidelines.
- Use antidepressants with caution in children and adolescents; refer to BNFC for details.#
- The following patient information leaflets are available:
- ‘Breast-feeding and antidepressant medication’ from Pharmacy Department, New Craigs, tel: 01463 704663
- ‘A handy factsheet on coming off antidepressants‘ on www.choiceandmedication.org/nhs24.
Note: Hyponatraemia (usually in older people and possibly due to inappropriate secretion of antidiuretic hormone) has been associated with all types of antidepressants and should be considered in the differential diagnosis of all patients who develop drowsiness, confusion or convulsions while taking an antidepressant.
Note: Antidepressant use in Bipolar Disorder
Although antidepressants are needed to treat bipolar depression their use may carry the risk of switching to manic states and may cause mood destabilisation:
- at the onset of a manic episode, stop the antidepressant; abrupt withdrawal may be justified in this situation.
- an antidepressant drug in combination with an antimanic drug is recommended for the treatment of acute bipolar depression.
- after successful treatment for acute depression, avoid maintenance antidepressant treatment.
- Lamotrigine (Antiepileptics) may be used after specialist initiation for the prevention of depressive episodes in bipolar disorder. Because of the risk of Stevens-Johnson syndrome/toxic epidermal necrolysis, the initial dose and subsequent slow dose escalation should not be exceeded; refer to SPC for further information.
- Quetiapine (Drugs use in psychoses and related disorders) may also be used after specialist initiation.