Recovery from depression

Contents

Contents

✖

iStock-1456035845-laptop_stethoscope_Dr_ID_6549.original

The three case scenarios give an example of how to review and audit prescribing and clinical notes of a patient who has mild to moderate depression and is prescribed an antidepressant medicine. After reading the therapeutic brief, consider the actions you would consider implementing for each case.

Once you have reviewed the case scenarios, use the patient audit tool (click here) to enter information for your patients who are prescribed an antidepressant to generate a customised audit report with actions to consider in reviewing their current regimen.

Case 1 Audit

GH, 35 years old, female, diagnosis of mild depression, prescribed an antidepressant medicine

Current medicine(s)	Class	Frequency of withdrawal syndrome	Severity of withdrawal symptoms
venlafaxine 150 mg modified release capsule	SNRI	Frequent	Severe

Patient Notes
How many months since clinical response to antidepressant treatment has been achieved?	18 Months
Does your patient wish to stop antidepressant?	Yes
Has your patient been taking antidepressants (of any class) for more than 2 years?	Yes
Any previous failed attempts to withdraw antidepressants? (medicine restarted due to withdrawal effects or relapse)	No
Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) requested in the last 2 years	No
GP management plan done in the last 2 years	Yes

Recommendations
	Consider discontinuing antidepressant. The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines recommend considering stopping antidepressants after a patient has been in remission for 9-12 months.
	Consider hyperbolic tapering of your patients’ antidepressant (patient has increased risk for antidepressant withdrawal syndrome). There is a higher success rate of stopping an antidepressant among patients who taper over months which reduces the risk of withdrawal symptoms compared to stopping the drugs abruptly or quickly (over weeks). For information about how to stop antidepressants see the RELEASE: REdressing Long-tErm Antidepressant uSE resources here.
	Consider a formal prescription of non-pharmacological interventions (social prescribing). Access My lifestyle plan for a template.
	Consider referral for a Medicines Review for an assessment of antidepressant deprescription strategy and optimisation of treatment regimen.

Case 2 Audit

JT, 46 years old, male, diagnosis of moderate depression, prescribed an antidepressant medicine

Current medicine(s)	Class	Frequency of withdrawal syndrome	Severity of withdrawal symptoms
fluoxetine	SSRI	Moderately frequent	Moderate

Patient Notes
How many months since clinical response to antidepressant treatment has been achieved?	13 Months
Does your patient wish to stop antidepressant?	Unknown
Has your patient been taking antidepressants (of any class) for more than 2 years?	No
Any previous failed attempts to withdraw antidepressants? (medicine restarted due to withdrawal effects or relapse)	No
Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) requested in the last 2 years	Yes
GP management plan done in the last 2 years	No

Recommendations
	Consider discontinuing antidepressant. The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines recommend considering stopping antidepressants after a patient has been in remission for 9-12 months.
	Consider slow tapering of antidepressants to avoid withdrawal syndrome. Closely monitor people for symptoms while they’re tapering their antidepressant. If experiencing withdrawal: non-existent to mild symptoms - continue with the tapering regimen and keep monitoring moderate to severe - allow more time before further reductions to see if the symptoms resolve severe - return the patient to the last dose at which they were stable and allow time to adjust and taper more slowly. For information about how to stop antidepressants see the RELEASE: REdressing Long-tErm Antidepressant uSE resources here.
	Consider a formal prescription of non-pharmacological interventions (social prescribing). Access My lifestyle plan for a template.
	Consider creating a GP management plan for your patient.

Case 3 Audit

RB, 52 years old, female, diagnosis of moderate depression, prescribed an antidepressant medicine

Current medicine(s)	Class	Frequency of withdrawal syndrome	Severity of withdrawal symptoms
escitalopram	SSRI	Moderately frequent	Moderate

Patient Notes
How many months since clinical response to antidepressant treatment has been achieved?	15 Months
Does your patient wish to stop antidepressant?	No
Has your patient been taking antidepressants (of any class) for more than 2 years?	No
Any previous failed attempts to withdraw antidepressants? (medicine restarted due to withdrawal effects or relapse)	Yes
Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) requested in the last 2 years	No
GP management plan done in the last 2 years	No

Recommendations
	Consider an early conversation with your patient about future withdrawal. Stopping the use of antidepressants might be an important step in a person’s recovery. A person may require more support to stop, with more regular GP appointments, while ensuring lifestyle, social and psychological factors are in place to help protect against relapse.
	Consider hyperbolic tapering of your patients’ antidepressant (patient has increased risk for antidepressant withdrawal syndrome). There is a higher success rate of stopping an antidepressant among patients who taper over months which reduces the risk of withdrawal symptoms compared to stopping the drugs abruptly or quickly (over weeks). For information about how to stop antidepressants see the RELEASE: REdressing Long-tErm Antidepressant uSE resources here.
	Consider a formal prescription of non-pharmacological interventions (social prescribing). Access My lifestyle plan for a template.
	Consider referral for a Medicines Review for an assessment of antidepressant deprescription strategy and optimisation of treatment regimen.
	Consider creating a GP management plan for your patient.