4.3 Antidepressant drugs

General guidance

• The main classes of antidepressant drugs include the tricyclics and related antidepressants, the selective serotonin re-uptake inhibitors (SSRIs), and the monoamine oxidase inhibitors (MAOIs).
• SSRIs are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression.
• Tricyclic antidepressants  ve similar efficacy to SSRIs but are more likely to be discontinued because of side-effects; toxicity in overdose is also a problem.
• MAOIs have dangerous interactions with some foods and drugs and should be reserved for use by specialists.

Recommended drugs

Selective serotonin re-uptake inhibitors

Fluoxetine £

Citalopram £

Paroxetine ££

Tricyclic and related antidepressants

Imipramine £

Amitriptyline £

Lofepramine ££

Others

Venlafaxine  (prescirbe as Vencarm brand) ££

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low