4.3 Antidepressant Drugs

NHS IOW Choice and Medication Website

NICE CG90 - Depression in adults: The treatment and management of depression in adults Oct 2009

NICE CG28 - Depression in children and young people: Identification and management in primary, community and secondary care Sept 2005

NICE CG91 - Depression in adults with a chronic physical health problem: Treatment and management Oct 2009 

Depressive disorder

Consider overdose risk when commencing a antidepressant

In the elderly there is an increased risk of intolerance to SSRI’s (hyponatraemia). It is important that doses are kept lower and it is known that the elderly may take longer to respond to treatment

Other tricyclics are available and may be used on an adhoc basis but it is important to be aware that some have become very expensive (£200 per month) so this should limit use, placing them in the yellow category. A clear rationale should be given for choosing above others.

 1st       FLUOXETINE   
 1st     CITALOPRAM  
 1st     SERTRALINE - Consider first if cardiac safety is an issue   
 2nd     MIRTAZAPINE  
 3rd     VENLAFAXINE  
 3rd     TRAZODONE  
 3rd     DULOXETINE  

Older person (65+) depressive disorder

1st        CITALOPRAM   
1st     SERTRALINE  
2nd     TRAZODONE  

Resistant Depression

      VENLAFAXINE (Yellow)    
      DULOXETINE (Yellow)   (for patients with cardiac problems only as an alternative to venlafaxine) 

Generalised anxiety disorder (GAD) / Panic disorder (PD) 

NICE CG113 - Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care Jan 2011

Licensed indications - G = General Anxiety, P = Panic Disorder

 1st     CITALOPRAM - P    
 1st     PAROXETINE - G/P    
 1st     ESCITALOPRAM - G/P    
 1st     SERTRALINE - P    
2nd     DULOXETINE (Yellow)    
2nd     VENLAFAXINE (Yellow)     

Social Phobia Post Traumatic Stress Disorder

NICE CG159 - Social anxiety disorder: recognition, assessment and treatment

1st     ESCITALOPRAM    
1st     SERTRALINE    
2nd     PAROXETINE    
2nd      VENLAFAXINE (Yellow)    
3rd       MAOI (Yellow) (for specialist initiation only)    

Obsessive Compulsive Disorder

NICE CG31 - Obsessive-compulsive disorder and body dysmorphic disorder

1st     ESCITALOPRAM    
1st     FLUOXETINE    
1st     PAROXETINE    
1st     SERTRALINE    
2nd     CLOMIPRAMINE    


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