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Use SSRIs first-line says NICE

GPs should use SSRIs in favour of tricyclics as first-line treatment for depression, according to draft guidance from the National Institute for Clinical Excellence.

In a ruling that overturns advice in the BNF, NICE states SSRIs are 'as effective' as tricyclics but less likely to be discontinued due to side-


The guidance highlights fluoxetine as a 'reasonable choice' as it is now available generically and associated with fewer withdrawal symptoms than other SSRIs.

The BNF says SSRIs are better tolerated than older drugs but the difference is

too small to justify always choosing an SSRI as first-line treatment.

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