Patient discussions
Discussions should focus on the potential beneficial effects and tolerability problems. Beneficial effects are hoped to emerge within 4 weeks but can be difficult to predict as can side effects. Therefore early and repeated reviews (i.e. within 2 weeks of initiation or dose incrementation) is a vital part of effective management. Patients should be fully informed of potential side-effects and discontinuation effects of antidepressants prior to initiation. Patients should regularly monitor their moods and degree of symptoms during treatment, and also thereafter, because persistent depressive disorder is a chronic condition and symptoms may return after successful treatment. Precautions regarding the use of antidepressant pharmacotherapy should be observed as per instructions for each medication. It should be emphasized that antidepressants can take a long time to take effect (up to 2-3 months at full dose [≥two-thirds of the maximum dose]) and generally have to be used long term to prevent the symptoms from coming back. Patients may also benefit from advice on how to manage the possibility of weight gain, as antidepressant use has been associated with an increased risk, particularly during the second and third years of treatment.[129]
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