Page 26 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

• at each review, monitoring for adverse effects, including extrapyramidal effects (for

example, tremor, parkinsonism) and prolactin-related side effects (for example, sexual
or menstrual disturbances) and reducing the dose if necessary

• being aware of any possible drug interactions which may increase the levels of some
antipsychotics, and monitoring and adjusting doses if necessary

• if there is rapid or excessive weight gain, or abnormal lipid or blood glucose levels,
investigating and managing as needed. [2022] [2022]

1.4.37 Manage antipsychotic prescribing under shared care arrangements. [2022] . [2022]

1.4.38 For people with depression who are taking an antipsychotic, consider at each
review whether to continue the antipsychotic based on their current physical
and mental health risks. [2022] [2022]

1.4.39 Only stop antipsychotics in specialist mental health services, or with their
advice. When stopping antipsychotics, reduce doses gradually over at least

4 weeks and in proportion to the length of treatment. [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 oral
antipsychotics as augmentation.

Use of St John's Wort Use of St John's Wort

1.4.40 Although there is evidence that St John's Wort may be of benefit in less severe
depression, healthcare professionals should:

• advise people with depression of the different potencies of the preparations available
and of the potential serious interactions of St John's Wort with other drugs

• not prescribe or advise its use by people with depression because of uncertainty about
appropriate doses, persistence of effect, variation in the nature of preparations and
potential serious interactions with other drugs (including hormonal contraceptives,

anticoagulants and anticonvulsants). [2009] [2009]

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