Addressing Antidepressant Concerns Through Education and Shared Decision-Making

As national discussions surrounding antidepressant use, deprescribing practices, and mental health policy continue to change, pharmacists are playing an increasingly important role in helping patients navigate complex and often emotionally charged conversations.

In an interview with Pharmacy Times, Megan Maroney, PharmD, BCPP, FAAPP, clinical associate professor at Rutgers' Ernest Mario School of Pharmacy, discussed recent federal initiatives related to antidepressant prescribing, concerns about medication withdrawal and stigma, and the importance of evidence-based shared decision-making. Maroney also highlighted the pharmacist’s role in patient education, safe medication management, and incorporating broader treatment strategies—including lifestyle interventions—into individualized mental health care plans.

Pharmacy Times: Can you introduce yourself?

Megan Maroney, PharmD, BCPP, FAAPP: Sure. My name is Megan Maroney. I'm a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers.

Pharmacy Times: Recently, initiatives aimed at reducing antidepressant prescribing and expanding deprescribing efforts were announced. From your perspective as a pharmacist, what has been your reaction to these announcements?

Maroney: So at first, I was a bit nervous, but when I actually took a look at the statement that was released by [Department of Health and Human Services] in the...Dear Colleague letter that was put out, it actually is outlined very well and, very evidence-based, everything that they've laid out in that document. So that gave me a little bit of comfort after reading through that.

Pharmacy Times: In your opinion, is the conversation regarding antidepressant withdrawal and/or long-term use overdue, or is there concern that it could further stigmatize treatment?

Maroney: There's always the chance that if things get misinterpreted or sensationalized, that that could create stigma, of course. But I do think that this is an important topic that needs to be discussed, and it's a concern that many patients already have or, you know, may have been afraid to bring up with their providers.

So I think it is good that we're discussing this and that there's education being provided on it because, you know, providers don't really get a lot of education on how to stop a medication or when to stop a medication. There's a lot of education about how to start the medication, what dose to use, but not a lot of education on how to take the patient off. And part of what they outlined in their plan, SAMHSA in particular, has outlined education opportunities that they're going to provide, and support for clinicians in doing this. So I think that's really important.

Pharmacy Times: One theme emerging from these federal initiatives is shared decision-making. What does that ideally look like when discussing antidepressants with patients?

Maroney: Absolutely. Shared decision-making is important in all areas of health care, but I think particularly so with mental health care. Patients have to be comfortable with the treatment plan, whether that be medication or nonmedication treatment, they have to really be on board for it to
really work, and with shared decision-making, you can always think of the mnemonic BRAN. That's B is benefits, R is for risks, A is alternatives, and N is nothing. So you always wanna discuss what are the potential benefits of a treatment, what are the potential risks for that specific patient for their, you know, all the factors [for] that patient that you have to consider, are there alternatives that might be effective or are useful for the patient, and what happens if you do nothing, if you don't treat, what are the risks for that as well, right? So that's something that I think is always important discussion to have, in any health care setting but again, particularly with mental health care.

Pharmacy Times: Do you worry that political rhetoric surrounding selective serotonin reuptake inhibitors (SSRIs) could lead some patients to abruptly stop their medications without medical supervision?

Maroney: There is always that concern, again, some individuals might get scared, or misinterpret, or get misinformed somehow, but I think, you know, as health care providers, pharmacists and other providers, we really you know, need to step up and provide the education and have those discussions with patients that if this is something that they're concerned about, whether they're, you know, maybe they've been on a medication for a long time and maybe they've been stable and they wanna know, "Well, is this time for me to come off?" Or maybe they're having side effects or concerns about side effects. It's really important to have that discussion with their treatment team and their providers, and come up with a plan. Is it appropriate to come off of the medication, and how would you do that safely?

Pharmacy Times: The current administration has also promoted lifestyle-based interventions such as nutrition, exercise, and even ketogenic diets as part of mental health care discussions. Where do you see those interventions fitting into psychiatric treatment?

Maroney: Lifestyle changes are so important, again, for physical health, for mental health. There's really good evidence for exercise for depression in particular. Aerobic exercise, also strength training, that's something that definitely should be incorporated into every treatment plan. So for patients with mild symptoms, it may be the primary treatment, but for patients with more moderate, severe symptoms, it can definitely be part of the overall treatment plan and should be part of that plan. So I think it's great that we're having, focus on this and discussing it more and, hopefully, be able to fund more studies to really see what works for individuals with mental health conditions.

Pharmacy Times: For patients currently taking SSRIs who may feel anxious after hearing these recent discussions in the media, what message would you want them to hear most clearly?

Maroney: Really to have that discussion with their treatment team, with their pharmacist, with their provider, they know their bodies best, and so it's really important, especially in, again, with mental health medications. It's not like we can check blood pressure or blood sugar and we know exactly what to do based on that. You have to communicate with your provider and your treatment team. So communicating those concerns, having that discussion, and coming up with a plan, that is evidence-based and will work for you specifically is the most important thing.