01 - Introduction to depression

Introduction to depression

The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M. Taylor, Thomas R. E. Barnes and Allan H. Young. © 2025 David M. Taylor. Published 2025 by John Wiley & Sons Ltd. Chapter 3 Introduction to depression Depression (major depressive disorder, MDD) is widely recognised as a major public health problem around the world. The mainstay of treatment is the prescription of antidepressants, although psychological treatments have a place as a first-­line alternative to antidepressants in milder and moderate forms of depression.1 Other methods of treating depression (vagal nerve stimulation [VNS],2 repetitive transcranial magnetic stimulation [rTMS],3,4 transcranial direct current stimulation,3 etc.) are also used but are not widely available. The basic principles of prescribing are described in Table 3.1, together with a summary of National Institute for Health and Care Excellence (NICE) guidance. Depression and anxiety disorders Table 3.1  Basic principles of prescribing in depression. ■ ■Discuss with the patient choice of drug and utility/availability of other, non-­pharmacological treatments. ■ ■Discuss with the patient likely outcomes, such as gradual relief from depressive symptoms over several weeks. ■ ■Prescribe a dose of antidepressant (after titration, if necessary) that is likely to be effective. ■ ■Assess the treatment’s efficacy within 2–4 weeks of initiation (sooner in young people). ■ ■Monitor treatment adherence and inform the patient about the risk of withdrawal symptoms. ■ ■Monitor for adverse effects. ■ ■For a single episode, continue treatment for at least 6 months after resolution of symptoms. Multiple episodes or high-­risk patients may require longer; continuing treatment may reduce the risk of relapse. ■ ■For patients continuing treatment, review treatment every 6 months. ■ ■Withdraw antidepressants very gradually; always inform patients of the risk, duration and nature of discontinuation symptoms.