Page 22 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

For a short explanation of why the committee made these recommendations and how they
might affect practice, see the rationale and impact section on starting and stopping
antidepressants.

For full details of the evidence and the committee's discussion, see the evidence reviews for
the NICE guideline on safe prescribing (evidence review A: patient information; evidence
review B: prescribing strategies; evidence review C: safe withdrawal; evidence review D:

withdrawal symptoms; evidence review F: monitoring.

Antidepressant medication for people at risk of suicide Antidepressant medication for people at risk of suicide

1.4.24 When prescribing antidepressant medication for people with depression who
are aged 18 to 25 years or are thought to be at increased risk of suicide:

• assess their mental state and mood before starting the prescription, ideally in person

(or by video call or by telephone call if in-person assessment is not possible, or not
preferred)

• be aware of the possible increased prevalence of suicidal thoughts, self-harm and
suicide in the early stages of antidepressant treatment, and ensure that a risk
management strategy is in place (see the section on risk assessment and management)

• review them 1 week after starting the antidepressant medication or increasing the
dose for suicidality (ideally in person, or by video call, or by telephone if these options
are not possible or not preferred)

• review them again after this as often as needed, but no later than 4 weeks after the
appointment at which the antidepressant was started

• base the frequency and method of ongoing review on their circumstances (for
example, the availability of support, unstable housing, new life events such as

bereavement, break-up of a relationship, loss of employment), and any changes in
suicidal ideation or assessed risk of suicide. [2009, amended 2022] [2009, amended 2022]

1.4.25 Take into account toxicity in overdose when prescribing an antidepressant
medication for people at significant risk of suicide. Do not routinely start
treatment with TCAs, except lofepramine, as they are associated with the
greatest risk in overdose. [2009, amended 2022] [2009, amended 2022]

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