2. Starting the consultation

Greet the patient, introduce yourself and confirm their identity. Check if it is still a good time to talk and ask how they would like to be referred to.

The consultation offers you an opportunity to find out how the patient feels about their new medication, what concerns they have, whether there are any barriers to compliance and their hopes for how it will help.

Talking to a professional can remove the emotion or worries a patient may have if they were talking to a friend, colleague or family member. For example, they may be worried about stress at work, not coping with family dynamics or have concerns about being viewed as a failure by their loved ones.

Start by acknowledging that being prescribed an antidepressant can be daunting and allow the patient space to express their views on what it means to them. Reassure them that this time is designed to help them make informed choices about their antidepressant medication, be aware of the risks and how to manage any side-effects.

Explain that every patient’s experience of medication is different, but there are general guidelines in terms of what they may encounter. This includes (but is not limited to) the following: 

• Antidepressants can take two to four weeks to  start working, so taking the medication for long enough to give it a chance to be effective is important
• It may take some time to adjust and find the right dose of the medication for the patient
• Side-effects may be experienced before the patient feels any benefit from the treatment
• Side-effects are often temporary and improve over time
• Very common side-effects of antidepressants include dry mouth, nausea, headache, sleepiness or insomnia
• Common side-effects include indigestion, abdominal pain, constipation, tremor, nightmares, agitation, anxiety and palpitations
• Antidepressants are not addictive but can cause discontinuation symptoms. Encourage the patient not to stop their medication without talking to a health professional
• There are many types of antidepressants and if one does not have the desired effect or has intolerable side-effects, there are different ones that can be trialled. 

Provide reassurance

Reassurance at this stage is helpful as patients who have not been informed about side-effects or the length of time it takes for the treatment to work will often disengage if they are feeling no benefit but are experiencing negative effects.

Check if they are taking other medications, including any over-the-counter medicines, herbal preparations, illicit drugs or alcohol.

Questions should be put to the patient in a non-judgemental manner and emphasise that you are asking them in order to check for interactions with the newly prescribed antidepressant.

If the patient is open to discussing this, offer signposting to an appropriate agency/care provider for further support.

Ask when they next have an appointment with their GP. The early stages of treatment when their mood is lifting is when patients are often at their most vulnerable. It is important to ensure they have support during this time as well as access to a repeat prescription for continuation of treatment.