Royal College of Psychiatrists – position statement on antidepressants and depression
In April, the Royal College of Psychiatrists issued a position statement on the use of antidepressants. It contained a number of recommendations about the treatment of depression. These are mainly based on the recommendations of NICE’s 2009 Depression Guidelines, although it does reference the draft version of the update of this guideline in places.
Antidepressants are not recommended for mild and sub-threshold symptoms. However, they may be appropriate in symptoms that last more than two years or do not respond to other treatments.
- Evidence-based psychological therapies are recommended for initial treatment.
- Antidepressants are recommended where psychological therapies are refused or ineffective, or symptoms of depression are severe.
- Antidepressants are not recommended for mild and sub-threshold symptoms. However, they may be appropriate in symptoms that last more than two years or do not respond to other treatments.
- In children and adolescents, antidepressants should usually be considered second-line treatments. However, they may be first-line in patients with severe symptoms and who are under the care of a psychiatrist.
The statement emphasises the importance of providing patients with enough information that they can give informed consent and states that treatment should be regularly reviewed.
It also highlights the need for the withdrawal of antidepressant treatment to be tapered downwards slowly to minimise the risk of withdrawal symptoms.