Website last updated 29/06/2025
Depression
Key Considerations
- Antidepressants commonly cause unpleasant side effects during the first 2 weeks of use, including sleeping problems and weight gain
- Antidepressants can affect individuals differently, so it may be necessary to try several options before finding the one that works best for a particular patient.
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- Patients should be reviewed at least yearly to assess their mental health and treatment
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- PHQ-9 can be used for patient's presenting with new symptoms of depression. It can also be used to assess the patient's mental health during follow up reviews.
Other considerations
- Older people may only present with physical symptoms or a deterioration in cognitive functioning​
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- Patients should be offered low-intensity psychological interventions such as CBT. This can be used alongside treatment.
Choosing the right medication
Initiating treatment
- Patients should be reviewed every 2-4 weeks after initiating or titrating antidepressant medication
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- It may be beneficial to review them more often if the patient is:
- Suffering with severe depression
- Aged between 18-25
- Having suicidal thoughts or thoughts of self harm.
Patients often experience unpleasant side effects in the first two weeks and should be encouraged to continue treatment unless the side effects are severe.
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- Once the patient's mental condition has stablised, they can be reviewed less often, however they should be reviewed at least once a year.
Titration
- Generally, a patient should stay on the initial dose for around 4-6 weeks before deciding to increase the dose or switch antidepressant treatment.
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- If the antidepressant is well tolerated and the patient wants to increase the dose earlier, they may do so after 2 weeks of treatment
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- If the patient is suffering with severe side effects, it would be beneficial to switch earlier
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- The dose of the antidepressant should then be increased, as needed, until the patient's mental health is stable. ​​
Down titration / stopping antidepressants
- Decreases in dose can be done every 2-6 weeks
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- Slower titration carries less risk of adverse effects
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- Decreases in dose can be considered once the patient's mental health is stable
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- Patients should be advised to continue antidepressants for at least 6 months before deciding to stop
Switching antidepressants
- Reasons for switching antidepressants can include:
- Treatment ineffectiveness
- Patient preference
- Unpleasant side effects
- Changes to the patient's health (for example pregnancy)
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Please see the table below on how to switch between different anti-deprssants
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Pregnancy
- SSRIs should be used as first line as there is the most fetal safety data
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- Take into account the risks of stopping the antidepressant vs the risk to the foetus
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- The mother should be advised of the potential risks
Safety netting
- All patients should be counselled on the side effects of the treatment, including the risk of side effects in the first 2 weeks
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- All patients should be safety netted on emergencies at every review:
- Call 111 in a mental health crisis
- Call an ambulance if they are going to harm themselves
FAQ's
How long can patient's stay on antidepressants
Long term use of antidepressants has been linked to an increase risk of conditions such as CHD, diabetes and stroke. However the risk of stopping treatment should be considered.