Antidepressants should be prescribed in line with NICE guidance. There are 3 relevant documents from NICE and the Trust has developed local guidelines for use of antidepressants in the relevant circumstances. An audit into prescribing of all psychotropic medication prescribed by adult mental health services was undertaken. Data includes the full prescribing for 936 patients (300 inpatients and 636 outpatients).

Of the 936 patients 526 patients (56%) were prescribed antidepressants. The prescribing of antidepressants is 95% monotherapy in line with trust and NICE guidance. There is a small amount of combination therapy some of which should be investigated further.

The SSRI antidepressants are recognised first choice antidepressants on the basis of efficacy and cost and 211 (42%) of the trust prescribing was SSRIs. However paroxetine is no longer recommended in the trust for the treatment of depression and there were 33 instances of prescribing paroxetine.

Other antidepressants may be chosen second or third line except for dosulepin which is not recommended for use and phenelzine which is only recommended as third line.

288 (58%) represented other antidepressants with 26 being for dosulepin.

Treatment with antidepressants should be as monotherapy unless the patient has recognised poor response to treatment. The addition of mirtazepine or mianserin to an SSRI is recognised as the most suitable combination therapy. There are 27 instances of prescribing more than one antidepressant, 11 of these show compliance with NICE guidance.