Administration

These drugs should be started in a small dose, increased every few days if well tolerated. The oral route is almost always used; some parenteral preparations exist but do not have any clear advantage and are now rarely used. It is often possible to give the total dose at night; this helps with sleep and improves compliance.

Many patients in fact begin to improve within days rather than weeks, possibly owing to the anxiolytic and hypnotic effects of these drugs, which are immediate. However, there may be a delay of 2 or more weeks before the antidepressant effect is manifested, and it is essential to counsel patients about this, especially as side effects are most prominent in the first week.

Even if a depressive episode seems to have recovered completely with drug treatment, the drug should be continued in full therapeutic dose for at least 6 months before dose reduction is considered.

Getting to Know Anxiety

Getting to Know Anxiety

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