Synopsis
Choose an antidepressant from individual benefits, harms, overdose safety, interactions, comorbidity and preference, prescribe a usable regimen and monitor early suicidality, activation, withdrawal and physical adverse effects at guideline-aligned intervals.
- Before prescribing, confirm indication and severity, previous response, bipolar history, suicide and overdose risk, pregnancy, physical illness, substances and all interacting medicines.
- SSRIs are commonly considered because of tolerability and relative overdose safety, but choose within and beyond the class according to the person's priorities.
- Discuss nausea, sleep and sexual effects, bleeding, hyponatraemia, activation, emotional blunting, driving impairment, discontinuation symptoms and expected onset.
Key red flags
New reduced sleep need, increased activity, grandiosity or risky behaviour after an antidepressant suggests mania or hypomania and requires prompt bipolar review.
Investigation priorities
Confirm diagnosis, bipolarity, risk, prior treatment, comorbidity, pregnancy, substances and patient priorities.
Management branches
Antidepressant treatment is an informed preferred option.
- Review bipolarity, suicide and overdose risk, previous treatment, pregnancy, physical illness, substances and interactions.
- Compare likely benefit, common and serious harms, withdrawal, dosing and monitoring with the person's priorities.
Key medicines
SertralineStart 50 mg orally once daily for adult depression; increase by 50 mg steps at intervals of at least one week when needed, to no more than 200 mg daily.
CitalopramStart 20 mg orally once daily in adults; maximum 40 mg daily, but use no more than 20 mg daily in adults over 65 or with hepatic impairment.