North East and North Cumbria
ICS Formulary
 
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4 Central nervous system
04-03-04 Other antidepressant drugs

These drugs are for use in patients not responding adequately to first-line treatments.


Agomelatine
Formulary
  • NETAG approved for the treatment of depression only following an adequate trial of at least three alternative antidepressant drugs at maximally tolerated doses (as described by NICE and as stated in the BNF).
  • Prescribing and monitoring should be initiated by specialist mental health physicians. 
    • Transfer of prescribing to primary care at around 6 months / when LFT monitoring completed following dose increase
Link  MHRA Drug Safety Update (Dec 2014): Agomelatine (Valdoxan): risk of liver toxicity
Link  North East and North Cumbria ICB: Agomelatine – Prescribing and Monitoring in Adults: Information for Primary Care

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Bupropion Hydrochloride
Formulary
  • 150mg prolonged release tablets
  • Resistant depression 
Link  MHRA: Bupropion (Zyban): risk of serotonin syndrome with use with other serotonergic drugs
Link  NENC Bupropion for resistant depression - Information for Primary Care

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Duloxetine
Formulary
  • For use on advice of psychiatrists as a third-line antidepressant - but only for use in patients who cannot tolerate high-dose (>150mg daily) venlafaxine, or patients with hypertension, established CHD or other cardiovascular risk factors which would make the use of high-dose venlafaxine undesirable.
  • Also approved for third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists.

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Mirtazapine
Formulary
  • Orodispersible mirtazapine tablets should only be prescribed for use when other formulations are unsuitable (more expensive).

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Reboxetine
Formulary
  •  Not licensed in the elderly

 

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Venlafaxine
Formulary
  • For patients on doses of 300mg/day or more. Green Traffic Light

 
Link  TEWV Depression medication pathway for adults

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Vortioxetine
Formulary
  • Only approved for use in accordance with NICE guidance. 
Link  NICE TA367: Vortioxetine for treating major depressive episodes

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