Additional support
Additional support
When discontinuing antidepressants, social and psychological support is helpful. Past experience of stopping should be explored as this can be informative for predicting what symptoms may arise again on tapering. Careful consideration of past attempts to stop may detect withdrawal symptoms being misdiagnosed as relapse.
Often patients will require some preparation for antidepressant tapering. This might include arrangements for lightening workload or family duties, or more focus on non-pharmacological coping skills (e.g. breathing exercises, exercise, hobbies, diary keeping and de-catastrophising).
Tapering is not recommended at periods of major change (e.g. moving house, getting divorced, the birth of a child). It is recommended to wait until things have subsided to increase the likelihood of a successful withdrawal.
There is some evidence that cognitive behavioural therapy can support antidepressant withdrawal, while other third sector organisations, such as Mind or the Recovery College, can be helpful in supporting patients through antidepressant discontinuation.
Making a reflective account – an example
You could use your conversations with patients about discontinuing medicines in depression and anxiety as part of your revalidation reflective account. Here is an illustration of what an example taken from your practice might look like to show how you would have met last year’s selected standards:
“I’m aware that some people taking SSRI antidepressants would like to stop them. After reading a module in Pharmacy Magazine about the practical aspects of withdrawal and the new NICE guideline on withdrawing antidepressants, I reflected on my own practice and how I might support patients more effectively in stopping as well as starting antidepressant therapy.
“Most pharmacies see a lot of patients with depression and dispense repeat prescriptions on a daily basis. Prior to reading the CPD module, although I had noticed that sometimes antidepressants are discontinued or dosages reduced, I was not sure what, if anything, my role might be in this area.
“So I briefed my team members to look out for when a regular patient has a prescription with a reduced dose or where an antidepressant seems to have been missed off a repeat prescription, and to bring this to my attention. I explained why extra support is needed when coming off an antidepressant and it turned out two of them had experience of a family member or friend having withdrawal side-effects.
“If and when a changed prescription is brought to my attention, I now have some strategies for starting a conversation that I feel quite comfortable with. Hopefully, we will be able to agree to involve the prescriber and I know that a person might go ahead and stop taking their antidepressant with or without formal professional support. It is my ethical responsibility to make sure they have access to the right information resources as well as local sources of mental health support.
“In terms of the GPhC Standards, I have demonstrated good leadership and communication skills in my team briefing, and furthered my professionalism by identifying key elements to discuss with patients with depression and exploring what local resources are available as part of my signposting role.”