Antidepressants

Question

Antidepressants are an important group of medicines which help patients who suffer depressive illness and anxiety disorders. As with all medicines, anti-depressants may be associated with side effects in some individuals, and information on side effects is included in the product information for prescribers (the Summary of Product Characteristics) and patients (the Patient Information Leaflet).

The safety of the use of anti-depressants in routine clinical practice is continually monitored by the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA monitors all data including reports of suspected adverse drug reactions submitted by healthcare professionals, patients and carers through the Yellow Card scheme, as well as published and unpublished data. As new data emerges it is carefully evaluated and, where appropriate, product information for prescribers and patients is updated and advice issued.

It is not possible to estimate how long on average patients receive antidepressants. The British National Formulary recommends that patients should be reviewed every 1–2 weeks at the start of antidepressant treatment. Treatment should be continued for at least four weeks (six weeks in the elderly) before considering whether to switch an antidepressant due to lack of an adequate response. In cases of partial response, the guidance is to continue for a further 2–4 weeks, and elderly patients may take longer to respond.

Following remission, antidepressant treatment should be continued at the same dose for at least six months (about 12 months in the elderly), or for at least 12 months in patients receiving treatment for generalised anxiety disorder as the likelihood of relapse is high. Current guidance advises that patients with a history of recurrent depression should receive maintenance treatment for at least two years.