East Sussex - Better Together
NHS

4.3 Antidepressant drugs

NICE CG90: Depression in adults

NICE CG28: Depression in children and young adults

Prescribing Advice

  • Paroxetine and Venlafaxine are most likely to cause withdrawal symptoms due to their short half-lives
  • Mirtazapine can cause significant sedation and weight gain, and may also cause agranulocytosis.
  • Treatments such as dosulepin, MAOIs, combinations of antidepressants and augmentation therapies should only be initiated and managed by specialists

For information about prescribing antidepressants in special situations, see this document

For information about switching between antidepressants, see this document

Serotonin Syndrome

Serotonin Syndrome results from serotonin hyperstimulation.

Symptoms are usually mild and can be managed by drug withdrawal.

Severe cases can lead to multiple organ failure and death.

Symptoms include:

restlessness
sweating
tremor, shivering
myoclonus
confusion
convulsions

Onset is usually soon after starting / changing dose.

Discontinuation symptoms (find patient information leaflet)

  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs
  • Specialist Only Drugs
  • Mixed Status