Toggle Main Menu Toggle Search

Open Access padlockePrints

Pharmacological management of unipolar affective disorder

Lookup NU author(s): Professor Hamish McAllister-WilliamsORCiD, Emeritus Professor Nicol Ferrier


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


Unipolar affective disorder, or depression, is the one of the leading causes of disability worldwide and its effective management is a high priority. Treatment is required whether or not the illness is seen as 'reactive' to circumstances or understandable. Guidelines for its management have been produced by the National Institute for Health and Clinical Excellence (NICE) and the British Association for Psychopharmacology (BAP). These recommend rating the severity of the illness and using this as a guide for treatment. For less severe depression, antidepressants are recommended only when a patient fails to respond to other interventions or there is a history of more severe depression. For moderate-to-severe depression, antidepressants such as citalopram or fluoxetine are recommended as first-line treatments. The management of treatment-resistant depression (failure to respond to two adequate courses of antidepressants) is complex. NICE includes recommendations to consider augmentation of an antidepressant with cognitive behavioural therapy or lithium, monotherapy with venlafaxine or phenelzine (the latter particularly for atypical depression), and the combination of mirtazapine plus a selective serotonin reuptake inhibitor. BAP guidelines also include consideration of atypical antipsychotic or tri-iodothyronine augmentation of antidepressants. Other strategies have limited data supporting them and are not recommended, or are for use only in specialist centres. © 2009 Elsevier Ltd. All rights reserved.

Publication metadata

Author(s): McAllister-Williams RH, Ferrier IN

Publication type: Review

Publication status: Published

Journal: Psychiatry

Year: 2009

Volume: 8

Issue: 4

Pages: 113-119

ISSN (print): 1476-1793

ISSN (electronic): 1878-7592


DOI: 10.1016/j.mppsy.2009.01.004