Page 23 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

Antidepressant medication for older people Antidepressant medication for older people

1.4.26 When prescribing antidepressant medication for older people:

• take into account the person's general physical health, comorbidities and possible
interactions with any other medicines they may be taking

• carefully monitor the person for side effects

• be alert to an increased risk of falls and fractures

• be alert to the risks of hyponatraemia (particularly in those with other risk factors for
hyponatraemia, such as concomitant use of diuretics).

See also the NICE guideline on dementia: assessment, management and support for
people living with dementia and their carers. [2009, amended 2022] [2009, amended 2022]

Use of lithium as augmentation Use of lithium as augmentation

1.4.27 For people with depression taking lithium, assess weight, renal and thyroid
function and calcium levels before treatment and then monitor at least every
6 months during treatment, or more often if there is evidence of significant
renal impairment. [2009, amended 2022] [2009, amended 2022]

1.4.28 For women of reproductive age, in particular if they are planning a pregnancy,
discuss the risks and benefits of lithium, preconception planning and the need
for additional monitoring. [2022] [2022]

1.4.29 Monitor serum lithium levels 12 hours post dose, 1 week after starting
treatment and 1 week after each dose change, and then weekly until levels are
stable. Adjust the dose according to serum levels until the target level is
reached.

• when the dose is stable, monitor every 3 months for the first year

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