Treatment Protocol

First line: Psychological therapy (Psychoeducation, social support, physical activities). Follow up for 4-6 weeks.

Fluoxetine 20 mg once daily (start 10 mg in elderly). If no improvement after 4-6 weeks, increase to 40 mg. Alternatively, Amitriptyline 50 mg at bedtime, increase to 100-150 mg.

Continue medication for at least 9-12 months. Reduce slowly over 4 weeks when stopping.