Depression and Anxiety Disorders

Abstract

Depression is widely recognised as a major public health problem around the world. The basic principles of prescribing are described in this chapter, along with a summary of NICE guidance. This chapter concentrates on the use of antidepressants and offers advice on drug choice, dosing, switching strategies and sequencing of treatments. Management of treatment‐resistant depression has been informed by the STAR*D programme. The 2019 PANDA trial results support the prescription of selective serotonin reuptake inhibitor antidepressants in a wider group of participants than previously thought, including those with mild to moderate symptoms who do not meet diagnostic criteria for depression or generalised anxiety disorder. Over the last two decades, ketamine, an uncompetitive N‐Methyl‐D‐Aspartate receptor antagonist and dissociative anaesthetic, has emerged as a novel and effective rapid‐acting antidepressant. Psychotic depression is an under‐identified disorder and may have a life‐time risk of up to 1%.