Monitoring

Ongoing monitoring of antidepressant use is important. NICE recommends that anyone considered not at increased risk of suicide should be seen two weeks after starting treatment, then every two to four weeks for the first three months. 

Someone who is regarded as being at increased risk of suicide or is younger than 30 years – as there is an increased prevalence of suicidal thoughts in the early stages of antidepressant therapy in this age group – should be monitored more frequently. 

If no improvement in symptoms is seen after two to four weeks, check the medication is being taken as directed; if it is, consideration should be given to increasing the dose or switching to a different antidepressant, while simultaneously providing extra support.

Patients may ask how long they will need to take the antidepressant for. In its guidance on the recognition and management of depression in adults, NICE says that treatment should be continued for at least six months after the relapse of an episode of depression. Continuing beyond that time frame depends on several factors: 

• The number of previous episodes of depression
• Any residual symptoms
• Any concurrent physical health problems and psychosocial difficulties. 

Someone who is regarded as at risk of relapse should continue for at least two years, says NICE.