Start antidepressant
Titrate (if necessary ) to recognised therapeurtic does.
Assess efficacy after 2 weeks
Assess weekly for a further 1-2 weeks
If still no response, consider increasing dose
Discuss choice of drug with the patient
Include:
Therapeutic effects
Adverse effects
Discontinuous effect
Likely time to respond
Suggest SSRI as first choice;
mirtazapine if sedation required
Refer to suggested treatments for resistant depression
Switch to a different antidepressant
Titrate to a therapeutic dose
Assess efficacy over 3-4 weeks
Continue for 6-9 months at full treatment dose
Consider longer -term treatment in recurrent depression
Effective
No effect
No effect
No effect
Switch to a different antidepressant
Titrate (if necessary) to therapeutic dose.
Assess over 3-4 weeks, increase dose as necessary
Poorly tolerated or no effect
Poorly tolerated
Effective
Maudsley Prescribing Guidelines : Drug treatment of depression
Treatment of depression
-
SSRIs are first line agents for the treatment of depression
-
If this is not sufficient, then the dose of the SSRI should be increased
OR
a different SSRI
OR
mirtazapine should be used
-
Other 2nd line agents include: Lofepramine, moclobemide, reboxetine
-
Failure to 2nd line treatment?
In this case an additional antidepressant from a different class can be used
OR
Augmentation therapy may be used
If you're not so great with flow diagrams, then the pannel below summarises the treatment of depression