4.3 Antidepressant drugs
NICE CG90: Depression in adults
NICE NG134: 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)
- 4.3.1 Tricyclic and related antidepressant drugs
- 4.3.2 Monoamine-oxidase inhibitors
- 4.3.3 Selective serotonin re-uptake inhibitors
- 4.3.4 Other antidepressant drugs
- First Line Drugs
- Second Line Drugs
- Specialist Initiated or Recommended Drugs
- Specialist Initiated Drugs with Shared Care Guidelines
- Specialist Only Drugs
- Mixed Status