Page 65 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

with an alternative SSRI. [2022] [2022]

1.10.6 For people with chronic depressive symptoms that significantly impair personal
and social functioning, who have not responded to SSRIs or SNRIs, consider
alternative medication in specialist settings, or after consulting a specialist. Take
into account that switching medication may mean that an adequate wash-out

period is needed, particularly when switching to or from irreversible MAOIs or
moclobemide. See the NICE clinical knowledge summary on switching
antidepressants. Alternatives include:

• TCAs

• moclobemide

• irreversible MAOIs such as phenlezine

• low-dose amisulpride (maximum dose of 50 mg daily, as higher doses may worsen
depression and lead to side effects such as hyperprolactinaemia and QT interval

prolongation).

In June 2022, this was an off-label use for amisulpride. See NICE's information on
prescribing medicines. [2022] [2022]

1.10.7 For people with chronic depressive symptoms that significantly impair personal
and social functioning, who have been assessed as likely to benefit from extra
social or vocational support, consider:

• befriending in combination with existing antidepressant medication or psychological
therapy; this should be done by trained volunteers, typically with at least weekly

contact for between 2 to 6 months

• a rehabilitation programme, if their depression has led to loss of work or their

withdrawing from social activities over the longer term. [2009, amended 2022] [2009, amended 2022]

1.10.8 For people with no or limited response to treatment for chronic depressive

symptoms that significantly impair personal and social functioning who have not
responded to the treatments recommended in the sections on further-line
treatment and chronic depressive symptoms, offer a referral to specialist
mental health services for advice and further treatment. See also the
recommendations on collaborative care. [2022] [2022]

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