Page 62 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

• continuing antidepressant therapy by either increasing the dose or changing the drug.

For example, by:

－ increasing the dose of the current medication (within the licensed dose range) if

the medication is well tolerated; be aware that higher doses of antidepressants
may not be more effective and can increase the frequency and severity of side
effects; ensure follow-up and frequent monitoring of symptoms and side effects
after dose increases.

－ switching to another medication in the same class (for example, another SSRI)

－ switching to a medication of a different class (for example, an SSRI, SNRI, or in
secondary care a TCA or MAOI); take into account that:

◇ switching medication may mean cross-tapering is needed; see the NICE
clinical knowledge summary on switching antidepressants

◇ switching to or from an MAOI, or from one MAOI to another, will need to take
place in, or with advice from, secondary care

◇ TCAs are dangerous in overdose, although lofepramine has the best safety
profile

• changing to a combination of psychological therapy (for example, CBT, interpersonal
psychotherapy [IPT] or STPP) and medication.

Consider whether some of these decisions and treatments need other services to be

involved (for example, specialist mental health services for advice on switching
antidepressants). [2022] [2022]

1.9.6 If a person's depression has had no or a limited response to treatment with a
combination of antidepressant medication and psychological therapy, discuss
further treatment options with the person and make a shared decision on how

to proceed based on their clinical need and preferences. Options include:

• switching to another psychological therapy

• increasing the dose or switching to another antidepressant (see recommendation
1.9.5)

• adding in another medication (see recommendation 1.9.9). [2022] [2022]

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