Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines

Cleare, Anthony J.; Pariante, Carmine M.; Young, Allan H.; Anderson, Ian M.; Christmas, David; Cowen, Philip J.; Dickens, Chris; Ferrier, I. Nicol; Geddes, John; Gilbody, Simon; Haddad, Peter M.; Katona, Cornelius; Lewis, Glyn; Malizia, Andrea L.; McAllister-Williams, R. Hamish; Ramchandani, Paul; Scott, Jan; Taylor, David; Uher, Rudolf

doi:10.1177/0269881115581093

Cited by 597 publications

(573 citation statements)

References 741 publications

(846 reference statements)

Supporting

Mentioning

537

Contrasting

Unclassified

Order By: Relevance

“…From the available literature there is a general consensus that the best method is to taper the drug slowly in order to avoid discontinuation symptoms. At present, the most recent antidepressant guidelines advise this method and recommend a minimum period of a 4-week taper following long-term treatment, preferably over months for a planned withdrawal of antidepressant medication [Cleare et al 2015]. However, as highlighted, some debate remains as to the optimum taper schedule implemented.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A review of the management of antidepressant discontinuation symptoms

Wilson

Lader

2015

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

Strong evidence supports the existence of a discontinuation syndrome following the withdrawal of antidepressant medication, particularly second-generation antidepressants. The syndrome is a common phenomenon and guidance as to best avoid the symptoms is essential for both practitioners and patients. The current study reviewed the available literature on the best methods of discontinuation for antidepressants in order to avoid or prevent the occurrence of any unpleasant side effects associated with antidepressant withdrawal. Accordingly, an electronic search of the PubMed/MedLine database and Google Scholar was conducted to find relevant literature published within the last 10 years. From this, 18 related articles were identified; five clinical studies, one case series, one consensus panel's recommendations and 11 literature reviews. Of the articles reviewed there is a general consensus as to tapering the drug slowly over a period of weeks or months. Also, in those patients who experience severe symptoms the drug should be reinstated and discontinued more gradually. The discontinuation syndrome does not occur as frequently or severely with longer-acting agents such as fluoxetine and therefore it is recommended that switching to this drug prior to withdrawal may be advisable. The articles reviewed also emphasize the need for patient education and reassurance throughout the discontinuation process. One in particular adds that cognitive behavioural therapy may be a useful tool in easing the patients' distress. However, this review highlights the lack of controlled data to support the available guidelines. Furthermore, the guidance which is available is somewhat conflicting. Research approaches should address this issue as well as develop appropriate methods of withdrawal for specific drugs.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Another set of guidelines covers all of the treatment of depression [Cleare et al 2015]. It is the official document of the British Association of Psychopharmacology (BAP).…”

Section: Panel Recommendationsmentioning

confidence: 99%

A review of the management of antidepressant discontinuation symptoms

Wilson

Lader

2015

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

show abstract

“…1 Combination treatment with antidepressant and antipsychotic medication (e.g. venlafaxine with quetiapine) is more effective than monotherapy for the treatment of depression with psychotic symptoms.…”

Section: Diagnosismentioning

confidence: 99%

“…1 These include assessing adequacy of dose and treatment adherence, and reviewing the diagnosis, including possible psychiatric or medical co-morbidity, but also considering chronic social difficulties involved in maintaining the symptoms. If the review after 4 weeks of adequate treatment shows some improvement, it is recommended to continue treatment for another 2-4 weeks, but proceed with the next-step treatment if there is insufficient improvement at 6-8 weeks.…”

Section: Next-step Treatment For Inadequate Responsementioning

confidence: 99%

Pharmacological management of depressive disorders

Cleare¹,

Dunčko²

2016

Medicine

View full text Add to dashboard Cite

This article outlines current guidelines for the pharmacological treatment of depression. For acute treatment of moderate to severe depression in the absence of specific factors, the recommendation is treatment with a selective serotonin reuptake inhibitor or mirtazapine. Other options for acute antidepressant treatment are discussed, and advantages and disadvantages of specific drugs are outlined. Recommendations for next-step treatment for patients with an inadequate response include increasing the dose, switching to another antidepressant, augmentation with another agent or using a combination of antidepressants. Again, recommendations for specific drugs are outlined, and the common advantages and disadvantages of specific drugs are listed in a table format. The options for non-pharmacological treatments are briefly explored in regards to symptom severity and other clinical features, and a list of non-pharmacological treatment options is provided.

show abstract

“…[1][2][3] Venlafaxine and mirtazapine are frequently prescribed options for third-line therapy. 3 Vortioxetine is a new antidepressant launched in the UK in 2015.…”

mentioning

confidence: 99%