For adults with depression who wish to start antidepressant treatment, the recommended first-line pharmacological options are selective serotonin reuptake inhibitors (SSRIs) or serotonin noradrenaline reuptake inhibitors (SNRIs) NICE CKS. These are recommended due to their tolerability and safety profile NICE CKS. A tricyclic antidepressant (TCA) may be preferred if the individual has responded well to it in the past and there are no contraindications NICE CKS. For people presenting with chronic depressive symptoms who have not received previous treatment for depression, SSRIs, SNRIs, or TCAs are also considered treatment options NICE NG222. It is important to note that St John's wort is not recommended for depression due to uncertainties regarding appropriate doses, persistence of effect, variation in preparations, and potential serious interactions with other drugs NICE CKS,NICE CG91. The choice of treatment should always be a shared decision, based on the person's clinical needs and preferences NICE NG222.
What are the recommended first-line pharmacological treatments for depression
Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP.
Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MSt MRCGPClinical Lead • iatroX
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