Dawaa Reference

Clinical reference

Major depressive disorder (mild-to-moderate)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

eMC SmPC, Efexor XL 150 mg prolonged release capsules (Viatris), sections 4.1 and 4.2 · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)

Verified against4 documents
  • eMC SmPC, Efexor XL 150 mg prolonged release capsules (Viatris), sections 4.1 and 4.2
  • Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909)
  • LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)
  • Major Depressive Disorder - disease-level clinical article (depression-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (11)

  • Low mood that will not lift, or losing interest and pleasure in things that used to be enjoyable [low mood]
  • Feeling guilty, or feeling worthless
  • No energy, and concentration that has gone
  • Appetite has changed, in either direction
  • Movement and speech slowed down, or the opposite - restless and unable to settle [irritability]
  • Sleep is disturbed - too little, too much, or broken
  • Thoughts of suicide, which must be asked about directly at every visit
  • Five of these nine are needed, and one of the five must be the low mood or the lost pleasure, and it must be costing them socially or at work [low mood]
  • In children and teenagers the mood may look irritable rather than sad [irritability]
  • Many arrive at the GP with a physical complaint instead, and never reach a mental health service
  • In roughly half of cases the patient denies feeling depressed, and it is the family or the employer who brings them, having noticed the withdrawal and the drop in activity

Signs — what you find (5)

  • There is no blood test for it - the diagnosis rests on the history and the mental state examination
  • The mental state examination is the central piece of the assessment, not a formality
  • Examine the patient properly, nervous system included, before settling on a psychiatric label
  • What the family or a friend tells you is part of the assessment, not an optional extra
  • Take the history wide: medical, family, social and substance use, alongside the symptoms themselves

Tests (5)

  • Bloods do not make the diagnosis - they are there to exclude a physical cause
  • The PHQ-9 is the primary-care instrument: nine questions the patient answers, matching the diagnostic criteria
  • A PHQ-9 of 10 or more, out of 27, points to the diagnosis
  • Hospitals use the Hamilton scale instead, and score only its first 17 items
  • Other scales in use are the Montgomery-Asberg, the Beck inventory, the Zung and the Raskin

If not this — what else fits (12)

  • Bipolar disorder - a past manic or hypomanic episode excludes this diagnosis and must be asked for
  • Longer-running low mood: dysthymia, or cyclothymia
  • Grief, or an adjustment reaction to something that has happened
  • Schizoaffective disorder or schizophrenia, where the mood problem is not the whole picture
  • An anxiety disorder, or an eating disorder
  • Neurological disease: stroke, multiple sclerosis, a subdural bleed, epilepsy, Parkinson or Alzheimer disease
  • Hormonal disease: diabetes, the thyroid, the adrenal glands
  • A metabolic upset - a high calcium or a low sodium
  • The drugs they are already on, or coming off: steroids, blood-pressure drugs, anticonvulsants, antibiotics, sedatives, alcohol, stimulant withdrawal
  • A deficiency: vitamin D, B12, B6, iron or folate
  • Infection - HIV and syphilis both do this
  • An underlying cancer

Scores

  • PHQ-9 — How severe is this depression?

SourceStatPearls "Major Depressive Disorder" - disease-level clinical article

Presentation findings are traced to the source above.

1

FLUOXETINE

1st line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg once daily in morning, titrate after 3-4 weeks up to max 60 mg daily - Long-term (continue 6 months post-remission)

Paediatric dose

(Child 8-17 yrs (specialist CAMHS supervision): 10 mg once daily, titrate to 20 mg)

Dose by age
8 to 17 years:10 mg once daily, titrated to 20 mg - under specialist CAMHS supervision
Dose source

Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909)

Why

First-line SSRI with activating profile and long half-life (less discontinuation syndrome)

Cautions
  • Warn patient that onset of antidepressant effect takes 2-4 weeks.
  • Monitor closely for suicidal ideation in young adults during initial weeks.
  • Do not combine with MAO inhibitors or serotonergic drugs (serotonin syndrome).
Egyptian brands
Egyptian brandManufacturerIndicative price
FLOROSIN 20MG 10 CAPS.UP PHARMA11.00 EGP (1.10/unit)
PHILOZAC 20MG 10 CAPS.AMOUN11.00 EGP (1.10/unit)
FLUOXETINE 20 MG 10 CAPS.MISR18.60 EGP (1.86/unit)
ELEVAMOOD 20 MG 28 CAPS.UNIPHARMA56.00 EGP (2.00/unit)
OCTOZAC 20MG 10 CAPS.OCTOBER PHARMA21.60 EGP (2.16/unit)
PHILOZAC 20MG 30 CAPS.AMOUN75.00 EGP (2.50/unit)
PROZAC 20MG 14 CAPS.ELI LILLY118.00 EGP (8.43/unit)
FLUOXETINE 20 MG H.G.CAPS.SIGMA8.00 EGP
2

SERTRALINE

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg once daily, titrate by 50 mg steps at 2-3 week intervals to max 200 mg daily - Long-term (continue 6 months post-remission)

Paediatric dose

Pediatric use restricted to OCD under specialist supervision

Choice

Alternatives, both first-line SSRIs. Sertraline is preferred where cardiovascular disease or age is a factor, which covers most of the patients started on one.

Dose source

LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)

Why

Preferred SSRI in patients with cardiovascular disease or elderly

Cautions
  • Do not combine with MAO inhibitors (risk of fatal serotonin syndrome).
  • Monitor closely for suicidal ideation during initial weeks (especially in patients <25 years).
  • Gastrointestinal side effects (nausea, diarrhea) are common initially.
  • Taper dose gradually when discontinuing to prevent withdrawal symptoms.
  • Caution with antiplatelets or anticoagulants (increased bleeding risk).
Egyptian brands
Egyptian brandManufacturerIndicative price
OPIRALINE 50 MG 20 F.C. TABS.EL-OBOUR29.00 EGP (1.45/unit)
AGRELOCIT 50 MG 20 TAB.MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES34.80 EGP (1.74/unit)
DEPR-STAT 50MG 10 CAPS.MEMPHIS21.60 EGP (2.16/unit)
SESERINE 50MG 30 TAB.ADWIA75.00 EGP (2.50/unit)
SERPASS 50MG 30 F.C.TAB.GLOBAL NAPI PHARMACEUTICALS102.00 EGP (3.40/unit)
SIRTO 50MG 10 F.C. TABS.HI-PHARM34.00 EGP (3.40/unit)
MOODAPEX 50 MG 30 F.C.TAB.MULTI-APEX111.00 EGP (3.70/unit)
LUSTRAL 50 MG 20 F.C.TABS.VIATRIS136.00 EGP (6.80/unit)
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Major Depressive Disorder - disease-level clinical article (depression-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Evaluation for suicidal or homicidal ideation is mandatory at each visit.
4

VENLAFAXINE

2nd line

Strength75 mg

Formoral.solid

Adult dose and duration

Prolonged release: 75 mg once daily. Increase at intervals of 2 weeks or more (not less than 4 days) up to a maximum of 375 mg/day - Continue for at least 6 months after remission; taper over at least 1-2 weeks, and considerably longer in practice, when stopping

Paediatric dose

Not recommended in children and adolescents - trials failed to demonstrate efficacy and there were more self-harm and hostility events.

Dose source

eMC SmPC, Efexor XL 150 mg prolonged release capsules (Viatris), sections 4.1 and 4.2

Why

30 live products. The condition currently holds two SSRIs and nothing else - venlafaxine is the standard next step for a patient who has not responded to an adequate SSRI trial, and the same SmPC also covers generalised anxiety, social anxiety and panic disorder.

Cautions
  • Dose-related rise in blood pressure. Measure blood pressure before starting and after each increase, and think hard before exceeding 150 mg/day in a hypertensive patient.
  • Withdrawal reactions are more severe and more common than with the fluoxetine and sertraline already listed - never stop abruptly, and warn the patient before they start.
  • More toxic in overdose than an SSRI - weigh this where there is self-harm risk, and limit the quantity dispensed.
  • Monitor closely for emergent or worsening suicidal thinking in the first weeks and in anyone under 25.
  • Do not combine with a monoamine oxidase inhibitor - leave 14 days between them. Efexor XL 150 mg hard prolonged release capsules SmPC section 4.5 (eMC product 1219): "Venlafaxine must not be used in combination with irreversible non-selective MAOIs." and "Venlafaxine must not be initiated for at least 14 days after discontinuation of treatment with an irreversible non-selective MAOI." The label also asks for 7 days the other way round, before an MAOI is started; the card's single 14-day gap is the more restrictive of the two.
  • Do not add to the fluoxetine or sertraline in this row - switch, with an appropriate cross-taper.
  • Venlafaxine can cause QT prolongation and arrhythmia, chiefly in overdose.
Egyptian brands
Egyptian brandManufacturerIndicative price
VENOXOR 75 MG 28 TABS.UNIPHARMA CO. > UNIPHARMA82.00 EGP (2.93/unit)
VENLAFAXINE 75MG SR 7 CAPS.GLOBAL NAPI PHARMACEUTICALS21.00 EGP (3.00/unit)
VEXAMOD 75MG SR 10 CAPSSIGMA30.00 EGP (3.00/unit)
GLOBEXOR 75MG 14 CAPS.GLOBAL NAPI PHARMACEUTICALS48.00 EGP (3.43/unit)
IDIXOR XR 75 MG 7 CAPS.INTERNATIONAL DRUG AGENCY (IDI) > NOVELL PHARMA32.50 EGP (4.64/unit)
EFEXOR XR 75MG 14 CAPS.WYETH AYERST LEDERLE-CANADA > VIATRIS EGYPT158.00 EGP (11.29/unit)
EFFEGAD 75 MG 30 E.R. CAPS.EPCI > HIKMA PHARMA90.00 EGP
VENLLAMASH 75 MG 30 EXT. REL. CAPS.MASH PREMIERE159.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.