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Which Antidepressant?

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Many patients who present to their GP with mild symptoms of depression will recover spontaneously so that an approach of ‘wait and see’ and using problem-solving strategies, is entirely reasonable in such cases.


In more severe cases, or where mild depressive symptoms have persisted for months or longer an antidepressant may be indicated possibly combined with CBT.


NICE guidelines suggest that a generic SSRI is prescribed in the first instance. Dosage should be titrated against symptomatic response, and if no change occurs after maximum dosage has been taken for six weeks, consider giving an antidepressant from a different class e.g. SNRIs such as venlafaxine or duloxetine, mirtazapine, agomelatine or a tricyclic compound.


Sometimes combining an SSRI with another compound can be effective. However, you need to be aware of the risk of the serotonin syndrome. If still no response, consider adding lithium in order to achieve a plasma level of 0.5-1.0mmol/l.


Other strategies include tryptophan, tri-iodothyronine.


ECT is of course useful in cases of refractory depression.

For appointments at all locations contact Carole on: 0203 633 0011

Weekend / early-morning consultations are available.

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