When starting antidepressant medication, the patient should be made aware of:¹²

• How the full effect requires time to develop
• The need to continue with treatment after remission
• Safety issues and adverse effects, and that addiction does not occur with antidepressants
• The risk of discontinuation symptoms, particularly with drugs with a shorter half-life such as paroxetine or venlafaxine.

Patients not considered to be at increased risk of suicide should be seen after two weeks and regularly after that. NICE recommends every 2-4 weeks for the first three months, and then at longer intervals if there is a good response to the antidepressant.

When initiating an antidepressant for someone considered to be at an increased risk of suicide, or who is under 30 years old (drug-induced suicidal ideation risk being higher in younger people), the patient should be seen after one week and frequently thereafter, until the risk is no longer considered clinically important.

If symptoms do not improve within two to four weeks, check that the drug is being taken as prescribed. If there is no or only minimal improvement after three to four weeks, increase support such as weekly contact, and consider either:

• Increasing the dose in line with the SPC; or
• Switching to an alternative antidepressant.