1. Pre-consultation

Starting a consultation about any subject can be daunting for both patient and pharmacist, so it is essential to prepare thoroughly beforehand.

There can be a stigma around mental health conditions in particular, which means that many patients may be reluctant to open up and discuss how they are feeling.

However, focusing on the medication allows the conversation to have a purpose and demonstrates that you as the pharmacist are there to support the patient. It also offers an opportunity for the patient to have vital one-to-one contact with a healthcare professional.

With depression, there is the potential for other co-diagnoses such as anxiety, or it may be that the patient is experiencing depression as a result of a diagnosis such as cancer or dementia. So it is worth spending some time reviewing the patient’s medication record prior to the consultation to see if there are any other newly prescribed medicines to take into consideration.

NMS and antidepressants

At the time of writing, plans are being finalised to include antidepressants in the New Medicine Service in England. With up to half of prescribed medications not taken as recommended or prescribed, the NMS enables patients to find out more about how their medication works and learn about any potential side-effects. It also gives patients the opportunity to ask questions and involves them in decision-making to manage their own condition and improve their health.

An important change to the NMS specification as originally envisaged is an alteration in the suggested follow-up timescales to allow the patient to take the antidepressant for a sufficient period to be able to properly assess its effects (see Table 1).

Patients can respond to antidepressants if the treatment is maintained for at least six months. Taking the medication consistently and regularly will help prevent relapse in the future.

During each stage of the proposed NMS, there will be an opportunity to signpost patients to non-medication support, including counselling via local services or groups, or online treatments such as eCBT (enhanced cognitive behavioural therapy).

A general wellbeing chat can be initiated, if appropriate, to check whether the patient is taking part in activities that are important to their sense of self and recovery.