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Introduction

In the UK, over seven million people are prescribed antidepressants every year. While prescribing rates are increasing – they are thought to have doubled in the past decade – this has not been associated with reduced rates of mental disability or suicide. Rates of non-adherence also remain high, and research suggests that up to half of patients may be taking antidepressants for longer than necessary.

The goal of deprescribing is to lessen medication burden and enhance quality of life. Discontinuing a medication is a patient-centred process, where the patient is the primary source of information. Although a lot is known about a drug’s mechanism and its side-effects, it is difficult to know what taking an antidepressant is like for the patient; how it affects their sleep, appetite, energy levels, sexuality, image, relationships or their mood. 

The only way to find out is by cultivating the right environment for them to share how they are affected, and that means asking the right questions. 

The question WHY

'Why' is a really important question but asking it can seem confrontational and people are unlikely to open up. They might instead tell you what they think you want to hear. A useful exercise is to try asking 'why' without using the actual word. 

Invite a colleague to ask you the suggested open questions below: 

  • What’s leading you to make this change?
  • How important is this change to you?
  • What’s not working at the moment?
  • What would be some benefits?
  • What things you are worried about?

Now invite them to ask you these 'Why' questions: 

  • Why do you need to stop your antidepressant?
  • Why don’t you want to carry on taking something that’s been helpful?
  • Why aren’t you taking your medication?
  • Why haven’t you been taking it as prescribed?
  • Why don’t you try and take it for a while longer, you might change your mind?

What difference, if any, did you notice about how the two sets of questions made you feel?