Page 63 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

1.9.7 Only consider vortioxetine when there has been no or limited response to at

least 2 previous antidepressants. See the NICE technology appraisal guidance
on the use of vortioxetine. [2022] [2022]

1.9.8 If a person whose depression has had no response or a limited response to
antidepressant medication does not want to try a psychological therapy, and

instead wants to try a combination of medications, explain the possible increase
in their side-effect burden. [2022] [2022]

1.9.9 If a person with depression wants to try a combination treatment and is willing
to accept the possibility of an increased side-effect burden (see
recommendation 1.9.8), consider referral to a specialist mental health setting or
consulting a specialist. Treatment options include:

• adding an additional antidepressant medication from a different class (for example,
adding mirtazapine or trazodone to an SSRI)

• combining an antidepressant medication with a second-generation antipsychotic (for
example, aripiprazole, olanzapine, quetiapine or risperidone) or lithium

• augmenting antidepressants with electroconvulsive therapy (see the
recommendations on electroconvulsive therapy for depression), lamotrigine, or
triiodothyronine (liothyronine).

Be aware that some combinations of classes of antidepressants are potentially
dangerous and should be avoided (for example, a SSRI, SNRI or TCA with a MAOI), and
that when using an antipsychotic the effects of this on depression, including loss of
interest and motivation, should be carefully reviewed.

In June 2022, this was an off-label use for some antipsychotics, lamotrigine, and
triiodothyronine (liothyronine). See NICE's information on prescribing medicines.

[2022] [2022]

For a short explanation of why the committee made these recommendations and how they
might affect practice, see the rationale and impact section on further-line treatment.

Full details of the evidence and the committee's discussion are in evidence review D: further-
line treatment.

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