NHG: TCA no longer first choice — PW

The NHG made this choice by looking at the effectiveness, degree of dropout, side effects, applicability and ease of use of the various antidepressants. Citalopram, escitalopram, fluoxetine and sertraline score the best overall. TCAs, such as amitriptyline, can be seriously toxic in the event of an overdose and have a relatively rapid life-threatening effect, especially due to the cardiotoxicity.

Transferring from a TCA to an SSRI in people who benefit from a TCA is not necessary, according to the NHG. Even if a TCA has been successfully applied in the past, doctors can prescribe it again. In addition, it is advised already achieving remission preferably continue treatment for at least six months if ppatients respond well to this and in recurrent depression for at least one year.

Starting dose for young adults

Furthermore, in the new standard, the recommended starting dose for young adults has been aligned with that for adults. When antidepressants are started, the risk of suicidality is slightly increased in patients aged 18 to 25 years. In the previous version of the standard it was therefore recommended to start with half a dose of an SSRI. This advice has been omitted in the new standard because of the risk of underdosing. The NHG has also found no scientific substantiation for the lower dose.

About 15% of pregnant women have depression or depressive symptoms. Doctors can prescribe sertraline according to the standard for women who are breastfeeding. Citalopram is also an option if you are pregnant or want to have children in the near future.

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