Page 20 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

• if, once very small doses have been reached, slow tapering cannot be achieved using

tablets or capsules, consider using liquid preparations if available

• ensure the speed and duration of withdrawal is led by and agreed with the person

taking the prescribed medication, ensuring that any withdrawal symptoms have
resolved or are tolerable before making the next dose reduction

• take into account the broader clinical context such as the potential benefit of more
rapid withdrawal if there are serious or intolerable side effects (for example,
hyponatraemia or upper gastrointestinal tract bleeding)

• take into account that more rapid withdrawal may be appropriate when switching
antidepressants

• recognise that withdrawal may take weeks or months to complete successfully. [2022] [2022]

1.4.18 Monitor and review people taking antidepressant medication while their dose is
being reduced, both for withdrawal symptoms and the return of symptoms of
depression. Base the frequency of monitoring on the person's clinical and
support needs. [2022] [2022]

1.4.19 When reducing a person's dose of antidepressant medication, be aware that:

• withdrawal symptoms can be experienced with a wide range of antidepressant

medication (including tricyclic antidepressants [TCAs], selective serotonin reuptake
inhibitors [SSRIs], serotonin–norepinephrine reuptake inhibitors [SNRIs], and
monoamine oxidase inhibitors [MAOIs])

• some commonly used antidepressants such as paroxetine and venlafaxine, are more
likely to be associated with withdrawal symptoms, so particular care is needed with
them

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