13 - References

References

340 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Toxicity in overdose varies both between and within groups of antidepressants42 (see section on psychotropics in overdose in Chapter 13). Duration of treatment Antidepressants relieve the symptoms of depression but do not treat the underlying cause. A reasonable amount of evidence suggests that they should be taken for 6–9 months after recovery from a single episode (presumably to cover the duration of an untreated episode). In those patients who have had several episodes, there is evidence of benefit from maintenance treatment for at least 2 years, but no upper duration of treatment has been identified (see section on antidepressant prophylaxis in this chapter). Beyond 2 years, continued treatment offers some benefits, but many people can safely stop at this point.43 There are few data on which to base recommendations about the duration of treatment of augmentation regimens. A minority view is that antidepressants worsen outcome in the long term.44 Next-­step treatments Approximately one-­third of patients do not respond to the first antidepressant that is prescribed. Options in this group include dose escalation, switching to a different drug and several augmentation strategies. A small proportion of non-­responders will respond with each treatment change, but effect sizes are modest and there is no clear difference in effectiveness between strategies (see sections on the management of treatment-­ resistant depression in this chapter). Use of antidepressants in anxiety spectrum disorders Antidepressants are first-­line treatments in a number of anxiety spectrum disorders (see section on anxiety spectrum disorders in this chapter). References

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