Adults - Depression
Suggested Medication Considerations before Referral from Primary to Secondary CMHT Care for Depression
Full treatment guidelines for primary care can be found at www.nice.org.uk/CG90
Before referring, unless significant suicide risk or pregnant :
1. Please check TFTs, FBC, UEC, LFT’s, glucose and CRP if clinically indicated. Consider IAPT services.
2. Prescribe an SSRI and increase to the maximum dose. We suggest using Sertraline however all the SSRIs are acceptable. Sertraline can now be prescribed at higher equivalent doses than Citalopram; Fluoxetine is very long acting and difficult to change or combine; Paroxetine causes agitation and is more difficult to stop than other SSRIs.
3. Please then consider prescribing the maximum daily dose of 375mg Venlafaxine (unless there is a personal or family history of bipolar disorder) using the chart below.
Commonly prescribed antidepressants can be changed using the following regime:
|
|
Week 1 |
Week 2 |
Week 3 |
Week 4
|
|
From Sertraline to Venlafaxine |
Sertraline 100mg* Venlafaxine m/r 37.5mg |
Sertraline 50mg Venlafaxine m/r 37.5mg |
Sertraline 25mg Venlafaxine m/r 75mg |
Stop Sertraline Venlafaxine m/r 112.5mg |
|
|
|
|
|
|
|
From Citalopram to Venlafaxine |
Citalopram 20mg Venlafaxine m/r 37.5mg |
Citalopram 10mg Venlafaxine m/r 37.5mg |
Citalopram 5mg
Venlafaxine m/r 75mg |
Stop Citalopram
Venlafaxine m/r 112.5 |
|
|
|
|
|
|
|
From Fluoxetine to Venlafaxine |
Fluoxetine 20mg |
Fluoxetine 10mg |
Fluoxetine 5mg |
Stop Fluoxetine Start Venlafaxine 37.5mg |
Venlafaxine can then be increased by 37.5mg a week or 75mg every two weeks.
Evidence: STAR –D trial - 2786 chronically depressed patients who received Citalopram 40mg a day, remission which was defined as a 50% reduction in symptoms score was only seen in 30%. Of those who did not recover and were switched to Venlafaxine, 25% then recovered.
*If Rx over 100mg a day of Sertraline, reduce by 50mg a week and start changeover when dose is down to 100mg a day.
COST NOTE: m/r capsules >> m/r tablets >> plain tablets
but m/r thought better tolerated
Counselling Services
Outlook Southwest
01208 871905
www.outlooksw.co.uk
Self-Referral
Pentreath
Promoting good mental health through personal development, education and employment.
http://pentreath.co.uk/
01726 862727
Self-Referral
Self Help
Mood Gym https://moodgym.anu.edu.au/welcome
Get Self Help www.getselfhelp.co.uk
Living Life to the Full www.livinglifetothefull.com
SOS
Re-Gain Listening, support and empowerment to people with emotional health issues in Cornwall & the Isles of Scilly.
http://www.re-gain.org.uk/
0808 8000306 (Free phone)
Samaritans
Confidential, emotional support for anyone in crisis www.samaritans.org.uk
08457 90 90 90 / 01872 277277