Mental Health Prescribing
This page contains information, links and resources around prescribing for mental health conditions.
Prescribing Guidelines by Clinical Area
One in four of us will be affected by emotional health or mental health problems at some point in our life.
This page contains information, links and resources around prescribing for mental health conditions. Please expand the topics below for more information.
For information on mental health services see the Somerset Mental Health and Learning Disabilities Commissioning Team page.
Antidepressant Prescribing
NHS Somerset Formulary page for antidepressants
The SPS have published new guidance on managing antidepressants in February 2023 including:
The SPS guide to switching antidepressants, with links to:
Establishing whether a person needs to switch their antidepressant
Choosing an antidepressant to switch a person to
Planning and agreeing an antidepressant switching strategy
Monitoring a person during and after antidepressant switching
With more links to specific drug classes and drugs.
See below for antidepressant choices in pregnancy and lactation under the perinatal mental health section.
Advice for prescribers- patient’s taking antidepressants with hyponatraemia
Hyponatraemia (usually in the elderly and possibly due to inappropriate secretion of antidiuretic hormone) has been associated with all types of antidepressants; however, it has been reported more frequently with SSRIs than with other antidepressants. Hyponatraemia should be considered in all patients who develop drowsiness, confusion, or convulsions while taking an antidepressant.
Hyponatraemia is associated with emergency admissions, especially in the frail elderly.
SFT have been receiving increasing numbers of referrals from primary care asking them to review patients who are taking antidepressants and have a finding of hyponatraemia. SFT advise:
- In mild hyponatraemia (>125mml/L -133mmol/L) monitor sodium and symptoms in the first instance, rather than switching patients away from a medicine that is effective for them. Consider appropriateness of continuing the antidepressant and/ or other medications being taken which may increase the risk of hyponatraemia (e.g. diuretics, NSAIDs, antipsychotics, carbamazepine, cancer chemotherapy, calcium antagonists, ACE inhibitors and laxatives).
- If serum sodium <125mmol/L discontinue the antidepressant immediately and seek specialist medical care.
- Discuss the risks (of hyponatraemia if continuing the antidepressant vs risks of depression coming back if stopping the antidepressant) with patient and record the decision in the patient notes
- If antidepressant not effective, then stop the antidepressant. Royal College of Psychiatrists advice can be found here: Stopping antidepressants | Royal College of Psychiatrists (rcpsych.ac.uk)
- Please continue to ask for advice where patients have severe or worsening hyponatraemia or where symptoms of hyponatraemia persist, preferably by phone or email with your local mental health team rather than making a referral.
Mendip CMHT
Wells Tel: 01749 836600
Taunton & Minehead CMHT
Taunton Tel: 01823 368350
Minehead Tel: 01643 701701
Somerset Coast CMHT
Bridgwater Tel: 01278 720220
South Somerset CMHT
Yeovil Tel: 01935 428420
Sedgemoor:
Telephone: 0300 1245601 (option 1)
Email: OPMHSedgemoor@somersetft.nhs.uk
The Maudsley Prescribing Guidelines in Psychiatry 14th Edition. Accessible via NHS library knowledge hub.
Depression / antidepressant use in pregnancy and lactation.
Please see the NHS Somerset information on prescribing SSRI’s and SNRIs in pregnancy and lactation January 2023.
The SPS have also recently published information on antidepressants used in lactation:
Safety in Lactation: Antidepressants – SPS Information from the Specialist Pharmacy Service who host UK Drugs in Lactation Service.
Use of selective serotonin reuptake inhibitors in pregnancy- UKTIS The UK Teratology Information Service page on SSRIs.
Antidepressants and Breastfeeding – The Breastfeeding Network and Anxiety and Breastfeeding – The Breastfeeding Network The Breastfeeding Network provide evidence-based resources aimed at the public.
Anxiety
The SPS have published information on Using beta-blockers during breastfeeding
Perinatal Mental Health Treatment provides free evidence-based resources for new parents and clinicians.
Bumps – best use of medicine in pregnancy The Bumps website is the public facing site of UKTIS.
Please see our Medicines used in Pregnancy and Breastfeeding and Medicines pages for further resources around prescribing in the perinatal period.
Comorbidities
Sleep hygiene measures should be taken when experiencing insomnia, for more information on supporting people with insomnia and treatments, please see the Hypnotics and Anxiolytics - NHS Somerset ICB page.
See our Neurodivergence page
Consider HRT for low mood associated with menopause.
Consider CBT for low mood or anxiety associated with menopause.
There is no clear evidence for SSRIs or SNRIs.
See our menopause webpage for further information and resources around menopause and hormone replacement therapy.
Depression / antidepressant use in pregnancy and lactation.
Please see the NHS Somerset information on prescribing SSRI’s and SNRIs in pregnancy and lactation January 2023.
The SPS have also recently published information on antidepressants used in lactation:
Safety in Lactation: Antidepressants – SPS Information from the Specialist Pharmacy Service who host UK Drugs in Lactation Service.
Use of selective serotonin reuptake inhibitors in pregnancy- UKTIS The UK Teratology Information Service page on SSRIs.
Antidepressants and Breastfeeding – The Breastfeeding Network and Anxiety and Breastfeeding – The Breastfeeding Network The Breastfeeding Network provide evidence-based resources aimed at the public.
Anxiety
The SPS have published information on Using beta-blockers during breastfeeding
Perinatal Mental Health Treatment provides free evidence-based resources for new parents and clinicians.
Bumps – best use of medicine in pregnancy The Bumps website is the public facing site of UKTIS.
Please see our Medicines used in Pregnancy and Breastfeeding and Medicines pages for resources around prescribing in the perinatal period.
Keeping Safe and Well
For the NHS Somerset Safeguarding information, please access the Safeguarding - NHS Somerset ICB page for information, relevant links and contacts.
See Somerset County Council and Somerset Survivors for more information.
Please see the Mental Health Services page for more information about mental health services in Somerset
Somerset Health and Wellbeing list a number of mental health resources.
Mind in Somerset provide support and resources and also run a 24/7 emotional support helpline.
Every Mind Matters provides a wealth of information and resources around mental health including anxiety, low mood, stress, sleep, youth and also relating to coronavirus.
NHS recommended apps are are free to download and use. Some may have in-app purchases.
The Somerset Emotional Wellbeing Podcast by NHS Somerset CCG’s Dr. Andrew Tresidder and Dr. Peter Bagshaw with special expert guests provides free mental and emotional wellbeing support.
The Somerset Emotional Wellbeing Staff Hub is a dedicated online resource for all health and care workers and volunteers in Somerset.
Suicide Awareness Training ‘Suicide Lets Talk’ can be found on the Somerset Health and Wellbeing website.
Samaritans offer a free helpline 24 hours a day, 365 days a year.
- The Mental Capacity Act (2005) (MCA) and deprivation of liberty safeguards (DoLS) during the coronavirus (COVID-19) pandemic
- The Mental Capacity Act 2005: deprivation of liberty safeguards
- Deprivation of liberty safeguards: a practical guide – The Law Society have produced a practical guide for identifying a deprivation of liberty which can be found on their website
- Social Care Institute for Excellence (SCIE): Deprivation of Liberty Safeguards (DoLS) at a glance
Serious Mental Illness
Improving physical healthcare for people living with severe mental illness (SMI) in primary care
The Lester Tool is recommended in the Somerset shared care guidance and nationally as a support for medication reviews in patients prescribed anti-psychotics. Although initially produced for SMI patients it should also be used as a resource for patients who also have a learning disability, autism or both and who are receiving anti-psychotic medication.
Physical Health Check For people with Severe Mental Illness information leaflet.
Depression / antidepressant use in pregnancy and lactation.
Please see the NHS Somerset information on prescribing SSRI’s and SNRIs in pregnancy and lactation January 2023.
The SPS have also recently published information on antidepressants used in lactation:
Safety in Lactation: Antidepressants – SPS Information from the Specialist Pharmacy Service who host UK Drugs in Lactation Service.
Use of selective serotonin reuptake inhibitors in pregnancy- UKTIS The UK Teratology Information Service page on SSRIs.
Antidepressants and Breastfeeding – The Breastfeeding Network and Anxiety and Breastfeeding – The Breastfeeding Network The Breastfeeding Network provide evidence-based resources aimed at the public.
Anxiety
The SPS have published information on Using beta-blockers during breastfeeding
Perinatal Mental Health Treatment provides free evidence-based resources for new parents and clinicians.
Bumps – best use of medicine in pregnancy The Bumps website is the public facing site of UKTIS.
Please see our Medicines used in Pregnancy and Breastfeeding and Medicines pages for resources around prescribing in the perinatal period.
Non-Pharmacological and Self-Help Treatments
Depression / antidepressant use in pregnancy and lactation.
Please see the NHS Somerset information on prescribing SSRI’s and SNRIs in pregnancy and lactation January 2023.
The SPS have also recently published information on antidepressants used in lactation:
Safety in Lactation: Antidepressants – SPS Information from the Specialist Pharmacy Service who host UK Drugs in Lactation Service.
Use of selective serotonin reuptake inhibitors in pregnancy- UKTIS The UK Teratology Information Service page on SSRIs.
Antidepressants and Breastfeeding – The Breastfeeding Network and Anxiety and Breastfeeding – The Breastfeeding Network The Breastfeeding Network provide evidence-based resources aimed at the public.
Anxiety
The SPS have published information on Using beta-blockers during breastfeeding
Perinatal Mental Health Treatment provides free evidence-based resources for new parents and clinicians.
Bumps – best use of medicine in pregnancy The Bumps website is the public facing site of UKTIS.
Please see our Medicines used in Pregnancy and Breastfeeding and Medicines pages for resources around prescribing in the perinatal period.
Somerset Talking Therapies provide a range of options to support anyone 18 years and older who lives in the Somerset area or who is registered with a Somerset GP. Patients are able to self-refer to Talking Therapies.
