Ongoing monitoring

Ongoing monitoring of therapy is very important. NICE recommends that anyone considered not at increased risk of suicide should be seen two weeks after starting treatment, then every two to four weeks for the first three months. 

Someone who is regarded as being at increased risk of suicide or is younger than 30 years of age (there is a potentially increased prevalence of suicidal thoughts in the early stages of antidepressant therapy in this age group) should be monitored more frequently. 

If no improvement in symptoms is seen after two to four weeks, check the medication is being taken as directed. If it is, consideration should be given to increasing the dose or switching to a different antidepressant, while simultaneously providing extra support.

Patients may ask how long they will need to take the antidepressant. In its guidance, NICE says that treatment should be continued for at least six months after the relapse of an episode of depression. 

Continuing beyond that time depends on several factors: the number of previous episodes of depression; any residual symptoms; and any concurrent physical health problems and psychosocial difficulties. Someone who is regarded at risk of relapse should continue on treatment for at least two years, says NICE.

Reflection exercise

Find out about local support groups, walking clubs, green gyms, library opening hours and volunteering opportunities, so you can signpost people quickly and easily.