NICE’s treatment recommendations for a new episode of less severe depression includes both cognitive/psychological interventions as well as SSRIs on their own. However, it says not to routinely offer antidepressant medication as first-line treatment for less severe depression unless it is the patient’s informed preference.¹⁴

For new episodes of more severe depression, talking therapies are again recommended, but antidepressants (and not SSRIs specifically) can be prescribed on their own or in combination with cognitive behavioural therapy (CBT).

Treatment choice will have been made depending on factors including the patient’s preference for specific medication effects such as sedation, concomitant illnesses or medications, suicide risk and previous history of response to antidepressant medicines.

Patients with chronic depressive symptoms which significantly impair personal and social functioning and who have not received previous treatment for depression, may initially have a wider range of drug treatment options. These can include SSRIs, SNRIs, or tricyclic antidepressants (TCAs) and/or CBT.

SSRIs should be initiated at the lowest effective dose, and sufficient time should be given, typically up to four weeks, to see what response there is and whether a dose increase might be necessary.¹⁵