Introduction and module overview

In the UK, 17 per cent of the population (7.3 million people) are currently taking antidepressants yet, while prescribing rates are increasing, rates of non-adherence remain high and outcomes poor.

Deprescribing is part of medicines optimisation and plays a vital role in managing chronic conditions, improving outcomes and avoiding adverse effects. The goal of deprescribing is to lessen medication burden and enhance quality of life. This module illustrates the steps that could be taken to discontinue an antidepressant and shows how the right conversation with the patient can support a safe and supportive decision.

Discontinuing medication is a patient-centred process, where the patient is the primary source of information. They should be asked what medications they value the most, which medications they feel they no longer need, and whether any medications are causing side-effects.

Although, as pharmacists, we know about a drug’s mechanism of action and side-effects, we probably don’t know what taking an antidepressant is actually like for the patient in front of us. For instance, we don’t know how it affects their sleep, appetite, energy levels, sexuality, image, relationships or mood. 

The only way to find this out is by cultivating the right environment in which the patient can tell us. For the patient, the most important thing is always simply being listened to. 

Community pharmacists can start a two-way conversation about a patient’s medicines by using open questions such as:

• “How are you finding taking your anti-depressant?”
• “What problems, if any, are you experiencing?”
• “Many people taking antidepressants think about stopping in the future, but don’t know how to broach that conversation with their care team. I wonder how you feel about that?”