- Promote and support non-pharmacological approaches, especially for mild and moderate depression.
- Discuss treatment options openly with patients (and carers), provide information and address any misconceptions.
- Take patient needs and preferences into account, as well as social and cultural factors, when making treatment choices
- Advise patients what to expect from antidepressant medicines and agree on an adequate trial period if starting treatment.
- Ask patients regularly about mood, function and adherence when monitoring treatment.
Medicinewise News: Exploring non-drug options in depression
Non-pharmacological options, such as cognitive behaviour therapy (CBT) and e-Mental health tools, are appropriate first-line treatments for mild depression. They are as effective as antidepressants in moderate depression.
Australian Prescriber: Switching and stopping antidepressants
Nicholas Keks, Judy Hope and Simone Keogh
Aust Prescr 2016;39:76-831 Jun 2016
Switching from one antidepressant to another is frequently indicated due to an inadequate treatment response or unacceptable adverse effects. All antidepressant switches must be carried out cautiously and under close observation.
Conservative switching strategies involve gradually tapering the first antidepressant followed by an adequate washout period before the new antidepressant is started. This can take a long time and include periods of no treatment with the risk of potentially life-threatening exacerbations of illness.
Clinical expertise is needed for more rapid or cross-taper switching as drug toxicity, including serotonin syndrome, may result from inappropriate co-administration of antidepressants. Some antidepressants must not be combined.
Antidepressants can cause withdrawal syndromes if discontinued abruptly after prolonged use. Relapse and exacerbation of depression can also occur. Gradual dose reduction over days to weeks reduces the risk and severity of complications.
Evaluation: GP survey results for Managing depression program
We surveyed GPs who participated in the NPS MedicineWise Depression: re-examining the management options visiting program to find out what they learned and whether they thought it was worthwhile.
Key survey findings:
- After the program there was in increase in GPs’ knowledge in relation to:
- use of fluoxetine as a first-line choice to treat adolescents when an antidepressant is required (+15%)>
- use of venlafaxine, based on adverse effects (+8%).
- GPs who participated in the program showed improved confidence at selecting antidepressants that do not interact with any concurrent medicines that their patient is taking (+4%).
- The proportion of GPs who would frequently refer their patients to online mental health programs increased (+5%).
- Overall, after the program a greater proportion of GPs selected an SSRI rather than an SNRI for the first-line treatment of severe depression.
Consolidate your knowledge about depression, brush up on current guidelines and practices and earn CPD points through our learning activities.
- Clinical e-Audit: Depression: Achieving remission, preventing relapse
- Online case study: Tailoring initial treatment in depression: Re-examining the options