Antidepressant monitoring in secondary mental health services: a scoping review of current UK guidelines and recommendations

OBJECTIVES: To identify and map current recommendations and guidelines for antidepressant monitoring in secondary mental health services, and to assess the extent to which existing guidance addresses the complexities of this setting. DESIGN: Scoping review conducted in accordance with PRISMA-ScR guidelines and JBI guidance. DATA SOURCES: We searched PubMed, Embase, PsycINFO, Scopus, and CINAHL from inception to September 2025. A grey literature search was also conducted, including guideline repositories and professional organisation websites. Eligibility criteria included peer-reviewed studies and UK-based guidelines or policy documents providing recommendations on antidepressant monitoring in adults within secondary mental health services were eligible. Commentaries and non-UK guidelines were excluded. Two reviewers independently screened records, extracted data, and mapped recommendations against four domains: suicide risk, adverse effects, physical health monitoring, and treatment efficacy. RESULTS: The search identified 846 records; following title and abstract screening, 10 full-texts were reviewed, and 1 peer-reviewed study was included. The grey literature search yielded five UK guideline documents (NICE, SPS, RCPsych, Maudsley, and a local NHS Trust policy). Across these, all sources acknowledged suicide risk, but only NICE and SPS provided specific recommendations for its monitoring. All guidelines commented on adverse effects, but only NICE and SPS recommended review at two weeks. None provided structured recommendations for physical health monitoring. Guidance on treatment efficacy was general, with no clear direction on methodology or timing, was primary care oriented with limited adaptation for secondary mental health services. CONCLUSIONS: Current UK guidance on antidepressant monitoring is largely generic and primarily oriented toward primary care, with limited adaptation for secondary mental health services. Gaps exist around physical health monitoring and systematic assessment of efficacy, while recommendations for suicide risk and adverse effects may not reflect the complexity of secondary care populations.