Washout period: 2 weeks before starting another serotonergic agent
Fluoxetine washout: 5 weeks before MAOI initiation
Selegiline transdermal patch: selective MAO-B inhibitor at low doses
6 mg/24h patch: dietary restrictions may not be required
Fewer drug interactions than oral MAOIs
Patient Discharge Instructions
copy discharge instructions
Diagnosis and basic information
You have been evaluated and the diagnosis is major depressive disorder (MDD)
This is a medical condition affecting brain chemistry, mood, and function
Treatment is effective: most people improve with the right medication and therapy
Your treatment plan today
Prescription provided: take as directed, do not stop suddenly
Follow-up appointment: scheduled within 7 days
Referral for psychotherapy if not already engaged
Medication instructions
Start antidepressant at the low dose provided and take every day
It may take 2 to 4 weeks before you notice improvement in mood
Side effects like nausea or headache in the first 1 to 2 weeks are common and usually pass
Do not stop your antidepressant without talking to your doctor first
Stopping suddenly can cause dizziness, electric shock sensations, and worsening mood
If you decide to stop, your doctor will create a slow tapering plan
Alcohol and recreational drugs worsen depression and interfere with medications
Avoid alcohol completely while on antidepressants
Safety planning
If you have thoughts of hurting yourself, call 988 (Suicide and Crisis Lifeline) immediately
Available 24 hours a day, 7 days a week
You can also text 988
Remove or secure dangerous items at home
Lock firearms in a gun safe or store outside the home
Dispose of extra medications or give them to a family member to hold
Your safety contact person: ask a trusted person to check in daily for the next 2 weeks
Return to emergency department immediately if
You are having thoughts of suicide with a plan or intent to act
You hear voices telling you to hurt yourself or others
You feel completely unable to take care of yourself (eating, drinking, basic hygiene)
You develop symptoms of serotonin syndrome
Agitation, confusion, rapid heart rate, fever, muscle twitching or stiffness
You develop signs of a manic episode
Feeling unusually energized or needing almost no sleep
Racing thoughts, impulsive spending, sexual behavior, or risk-taking
You experience a seizure (if taking bupropion)
Lifestyle recommendations
Physical activity: 30 minutes of moderate exercise most days is proven to reduce depression severity
Sleep hygiene: consistent sleep and wake time, limit screens before bed
Social connection: maintain contact with supportive people even when motivation is low
988 Suicide and Crisis Lifeline: call or text 988 anytime
References
Guidelines and key sources
DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision
American Psychiatric Association (2022)
Diagnostic criteria for MDD, bipolar disorders, and differential diagnosis framework
RANZCP Clinical Practice Guidelines for Mood Disorders
Malhi GS, Bell E, Singh AB et al., Bipolar Disorders (2020)
Evidence-based framework for MDD assessment and pharmacotherapy
VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder
Department of Veterans Affairs and Department of Defense (2022)
Stepwise management algorithm for MDD in primary care and specialty settings
ACP Living Clinical Guideline: Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of MDD
Qaseem A et al., Annals of Internal Medicine (2023)
Class I recommendation for CBT and SSRIs as first-line treatment
JAMA Review: Management of Depression in Adults
Simon GE, Moise N, Mohr DC, JAMA (2024)
Comprehensive evidence synthesis for pharmacotherapy and psychotherapy
Lancet Review: Major Depressive Disorder
Malhi GS, Mann JJ, Lancet (2018)
Pathophysiology, epidemiology, and treatment-resistant strategies
Landmark trials and scoring tools
PHQ-9 validation study
Kroenke K, Spitzer RL, Williams JB, Journal of General Internal Medicine (2001)
PHQ-9 sensitivity 88%, specificity 88% at score ≥10 cutoff
STAR*D trial
Rush AJ et al., NEJM (2006)
Up to 70% of patients fail initial antidepressant; stepwise augmentation strategy
TADS trial: adolescent MDD
March J et al., JAMA (2004)
CBT + fluoxetine combination superior to either alone in adolescent MDD
Esketamine approval evidence
FDA approval (2019) for TRD and MDD with acute suicidal ideation
Rapid onset within hours; REMS program required
CANMAT 2025 guidelines for MDD
Coles S, Wise D, American Family Physician (2025)
Updated evidence-based recommendations for first- and second-line treatments
Late-life depression review
Kok RM, Reynolds CF, JAMA (2017)
Escitalopram and sertraline preferred; avoid TCAs and paroxetine in elderly
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.