When Nicole Allison, MSN, PCNS-BC, prescribing clinical nurse specialist at The Providence Center, Providence, RI, went online to see what people thought about a recent study showing the response to antidepressant medications may be minimal or nonexistent in patients with mild or moderate symptoms, she was dismayed (Fournier, 2010).
"I was really surprised to find many seemed to support the idea that antidepressants may not be helpful for many patients who are already taking them," she said. "This was alarming, as virtually all of my professional colleagues who discussed the study shared their concerns regarding generalizations patients may infer regarding antidepressants and psychotropic medication without really understanding the serious nature of depression and possible co-existing disorders."
One Size Doesn't Fit All
While the study substantiated the effectiveness of anti-depressants in people with severe depression, Allison is convinced drug therapy is not a "one-size-fits-all" approach.
"We see so much improvement, with lives changing dramatically for the better, when we carefully evaluate a patient for mental illness, keep focus to the importance of therapy, exercise, diet, support systems, and, if clinically indicated, prescribe appropriate medication," she said.
Mary Collins, MS, NPP-BC, assistant professor of clinical nursing and specialty director of the University of Rochester School of Nursing's Adult/Family Psychiatric Nurse Practitioner program, explained the need to customize drug therapy.
"If a patient in a med/surg setting asks a nurse about stopping his antidepressant medication based on these study findings, I'd recommend the nurse talk with the patient to get a better understanding of the situation," she said. "The nurse can ask what prompted the patient to go on the psychotropic medication in the first place. Did the patient go on an antidepressant because he presented with a laundry list of depression symptoms years ago, or was it a major depressive episode? Is the patient receiving ongoing care and counseling? Any decision to change a medication ought to go under careful review by the person prescribing that medication."
Deborah Mindnich, MS, RN, CS, psychiatric clinical nurse specialist at McLean Hospital, Belmont, MA, shared some talking points for nurses to follow when a patient asks about stopping antidepressant medication.
"If a patient came to me with that question, I'd take a really close look at the symptoms of depression," she said. "I ask whether these symptoms interfere with the patient's ability to live his activities of daily life. If someone is socially withdrawn, not sleeping well, able to get to work most days but lacking energy, and doesn't have many friends, the depression is interfering with his life. If the antidepressant medication has made a difference in his life, I would say stay on that drug."
Allison described how she partners with patients at McLean to make sound decisions.
"I recommend the nurse talk with the individual about why she wants to go off the medication, explain the limits of the study, review history and previous attempts at tapering and discontinuing medication," she said. "If Sally Jones is doing well after 6 months on fluoxetine 20 mg, perhaps part of the reason she's doing well is because she is responding to treatment. It's important to provide ongoing psycho-education and medication teaching within the context of the patient's treatment plan. Tapering medication and providing follow-up visits after the patient has gone off the medication are keys for transitional periods in treatment."