Page 25 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

1.4.32 Consider electrocardiogram (ECG) monitoring in people taking lithium who

have a high risk of, or existing, cardiovascular disease. [2009] [2009]

1.4.33 Provide people taking lithium with information on how to do so safely, including
the NHS lithium treatment pack. [2022] [2022]

1.4.34 Only stop lithium in specialist mental health services, or with their advice. When
stopping lithium, whenever possible reduce doses gradually over 1 to 3 months.
[2022] [2022]

For a short explanation of why the committee made these consensus recommendations and

how they might affect practice, see the rationale and impact section on use of lithium as
augmentation.

Use of oral antipsychotics as augmentation Use of oral antipsychotics as augmentation

In June 2022, use of antipsychotics for the treatment of depression was an off-label use for some
antipsychotics. See NICE's information on prescribing medicines.

1.4.35 Before starting an antipsychotic, check the person's baseline pulse and blood
pressure, weight, nutritional status, diet, level of physical activity, fasting blood
glucose or HbA1c and fasting lipids. [2022] [2022]

1.4.36 Carry out monitoring as indicated in the summary of product characteristics for
individual medicines, for people who take an antipsychotic for the treatment of
their depression. This may include:

• monitoring full blood count, urea and electrolytes, liver function tests and prolactin

• monitoring their weight weekly for the first 6 weeks, then at 12 weeks, 1 year and

annually

• monitoring their fasting blood glucose or HbA1c and fasting lipids at 12 weeks, 1 year,

and then annually

• ECG monitoring (at baseline and when final dose is reached) for people with

established cardiovascular disease or a specific cardiovascular risk (such as diagnosis
of high blood pressure) and for those taking other medicines known to prolong the
cardiac QT interval (for example, citalopram or escitalopram)

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