Four "golden rules" for prescribing antidepressants have been set out by a pharmacist from the Maudsley hospital in London.
The rules are to be published in a new edition of the Maudsley prescribing guidelines by Mr David Taylor (chief pharmacist and lead author of the guidelines). He comments: "The treatment of mental illnesses, particularly depression, is often made too complicated for general practitioners, who often have very limited time. These four rules are the gold standard to apply."
The rules reflect what Mr Taylor describes as the "crucial factors in depression" - compliance, use of therapeutic doses and duration of treatment. The first rule is to discuss with patients the choice of drug. The second and third are to prescribe a recognised effective dose of antidepressant (after careful titration where necessary) and to continue treatment for at least four months after resolution of symptoms. The final rule is that the drug should be withdrawn gradually over two to four weeks, or longer if necessary.
Mr Taylor says that if a patient is unresponsive to one class of antidepressant then he would try switching to another class.
The Maudsley prescribing guidelines (sixth edition) will be available in October from Martin Dunitz (telephone 020 7482 2202).