• Tricyclics can be given once daily (usually in the evening).
• There is a delay in onset of action of 1-2 weeks after a therapeutic dose (equivalent to 150 mg imipramine at least) is reached.
• Each drug should have a clinical trial at an adequate dose for at least 4-6 weeks before treatment is changed.
• The SSRIs are probably now the first-line drugs of choice and the tricyclics second-line.
• Consider referral if there is a failed (adequate) trial.
• Full recovery may take up to 6 weeks or longer (in those who respond).
• Continue treatment at maintenance levels for at least 6 to 9 months. 1 There is a high risk of relapse.
• For a second episode use antidepressants for 3 to 5 years.
• MAOIs are often the drugs of choice for neurotic depression or atypical depression. 1
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