Remarks y The term “depression” refers to moderate-to-severe depressive episode or disorder. y The term “remission” is defined as relief from depressive symptoms. y The studies identified in the review included people experiencing first or recurrent episodes of depression. y Antidepressants are typically most effective in the initial 6–12 months and should only be continued where there is need and clinical oversight.

Implementation considerations y Long-term antidepressant use may be associated with additional adverse effects such as weight gain. y Specific types of antidepressants selected should carefully consider factors such as demographic characteristics (e.g. higher risks that may be associated with pregnancy or older age) and side-effects profiles (e.g. sexual dysfunction, sleep problems, weight gain). y When discontinuing antidepressants, abrupt discontinuation should be avoided and medicine doses should be tapered off slowly. Any withdrawal symptoms should be closely monitored. y Providers should keep in mind the possible adverse effects associated with antidepressants, the ability to deliver either intervention (in terms of expertise, and/or treatment availability) and individual preferences. Discontinuities in drug availability (common in LMICs) may interfere with continuation of treatment. y Costs accumulate with duration of prescription. Cost of daily dose of generic antidepressants varies from region to region throughout the world ranging between 3% and 9% of minimum wage (131).