19.01.4 General Considerations with the use of Antidepressants

Initial antidepressant drug therapy follows “start low, go slow”, the lowest dose is usually administered first and gradually increased as needed. Abrupt cessation of these drugs generally leads to withdrawal effects, which can be quite alarming with some classes such as the SSRIs, thus gradual weaning over weeks to months is recommended. A combination of antidepressant drugs is not recommended, it does not improve clinical efficacy and provides the opportunity for major drug-drug interactions. A number of studies have suggested that antidepressant drugs may increase suicide risk when first taken. This is often because improvement does not occur in the first few weeks, which may worsen depression and suicidality. As a result, close monitoring of at-risk patients must occur during this period. Antidepressant drugs are generally administered for 4-6 months, as this timeframe has shown to improve symptoms of depression and reduce relapse, however some sufferers of depression remain continuously medicated.