Management of Depression
Careful patient monitoring is required both when antidepressant treatment is initiated and stopped
Depression is one of the leading causes of disability worldwide1 and is estimated to affect up to 1 in 6 adults in Great Britain2,3,4. Antidepressants are being increasingly prescribed in the UK; a recent article in the Health Service Journal (9th August 2023) stated that there has been an increase of 40% in the prescribing of sertraline prescriptions since 2019. Consequently, there are concerns over adequate patient monitoring by GPs due to this additional demand as any patients being treated with antidepressants should be monitored closely, especially in the initial months of starting a new medication, as there can be a heightened risk of suicide in the initial stages.
Patient monitoring when deprescribing antidepressants, for obvious reasons is also incredibly important. In the recent update to the NICE QS8 quality standard on depression5 in adults, a new quality statement was that ‘adults with depression who are stopping antidepressant medication have the dose reduced in stages’.
The NHS has recently launched the ‘National medicines optimisation opportunities’ for 2023/246 which identifies 16 national medicines optimisation opportunities for ICBs which are designed to improve healthcare outcomes, tackle inequalities, enhance productivity and value for money and help the NHS support broader social and economic development. One of the areas covered is ‘addressing inappropriate antidepressant prescribing’, and this incentivises GPs to deprescribe antidepressants if they are no longer required by a patient.
Careful management of patients who are initiated with antidepressants or when treatment is stopped is required to maintain patient safety.