According to the latest recommendations from the High Health Authority, antidepressants are not indicated for mild depression. But these drugs can be considered for moderate depression and must, on the other hand, be offered from the outset. for severe depression.
For the choice of drug, the HAS recommends that doctors prescribe “the best tolerated antidepressant, the least toxic in the event of an overdose, and the easiest to prescribe, at an effective dose”.
First-line prescribed antidepressants
Because of their better tolerance:
- selective serotonin reuptake inhibitors (SSRIs);
- serotonin and norepinephrine reuptake inhibitors (SNRIs);
- three “other antidepressants” (of different pharmacological mechanism): mianserin, mirtazapine and vortioxetine.
When the first treatment has no effect
- In second intention : imipramine (tricyclic) antidepressants, because of their risk of cardiovascular toxicity.
- In third intention : agomelatine, due to its liver toxicity and tianeptine, which carries a risk of abuse and dependence.
- Last resort : monoamine oxidase inhibitors (MAOIs), only after other alternatives have failed due to their many adverse effects and drug interactions.
Follow-up and discontinuation of treatment
It is recommended to closely monitor the patient by regular consultations, especially after the first week and then the second week of treatment, to look for suicidal behavioragitation as well as somatic side effects.
Concomitant treatment by benzodiazepine may thus be justified at the start of antidepressant treatment for a period of 2 weeks in the event of disabling anxiety, agitation or insomnia.
The total duration of antidepressant treatment is between 6 and 12 months after remission, in order to prevent relapses. Discontinuation of treatment should not be done at the initiative of the patient or his family without medical support.
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Towards fast-acting antidepressants?
