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18 - References

References

346 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 in treatment (British Association for Psychopharmacology guidelines suggest 4 weeks).3 If there is some improvement at this time, continue and assess for a further 2–3 weeks (see section on general overview of antidepressants in this chapter). ■ ■Our algorithm conveniently dichotomises outcome as response or non-­response (effective, not effective). Real-life outcomes include partial response  – a positive change that falls short of recovery or remission. In those circumstances there is little evidence to guide practice, but the aim should be to achieve remission by means of dose increase and, if unsuccessful, by changing the antidepressant. ■ ■Adjunctive treatments shown to be effective after the failure of only one antidepressant (early-­stage treatment resistance) include (es)ketamine, risperidone, lithium and aripiprazole.36 Dextromethorphan may improve initial outcomes if added to SSRI treatment.37 References

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