Community pharmacists are in a position that may determine the difference between a successful or an unsuccessful antidepressant treatment regimen.
How many times have you had a patient come to the counter with a prescription for an antidepressant medication, knowing that he filled a different antidepressant medication only 2 weeks earlier? You meet the patient at the counseling area to discuss the medication, and you ask why the previous medication was stopped.
The patient then tells the story of how 2 or 3 days after he started treatment, he didn’t like the way he was feeling, so he decided to top the treatment. Two weeks later at a follow-up appointment with his physician, he described feeling uncomfortable, agitated, and irritable due to the medication, so his primary care physician wrote a prescription for a different antidepressant medication. The patient tells you that his doctor said this one may have a slightly different effect, and the side effects may not be as noticeable.
Somewhere along the line, the patient was not counseled appropriately about his antidepressant medication treatment. It could have been at the physician’s office, where the patient had described how he was feeling, and then the physician wrote a prescription and sent him on his way. Perhaps it was at the busy pharmacy counter, where the patient may have been offered the opportunity to decline counseling rather than being asked to step over to the counseling area because the pharmacist would like to speak with him about his medication.
When a patient picks up an antidepressant medication for the first time, it is important to spend some time with him or her to describe how the medication works. It helps when patients understand the function of neurotransmitters and how an antidepressant medication can help elevate and then balance the level of neurotransmitters in the patient's system.
When patients start a medication, their doctor may have them begin at a reduced dose and slowly increase over the course of 1 or 2 months. This is done to keep the side effects of the medication to a minimum while titrating up to the most appropriate dose for the condition.
Patients need to realize that during the first week of therapy, they may feel a little anxious, agitated, tired, or irritable. The neurotransmitters in their brain are being adjusted, and this may cause all sorts of uncomfortable feelings. Usually, these are transient side effects and will shortly pass.
It may take 7 to 14 days for the neurotransmitters to become balanced, and a good 5 weeks before the patient sees how well this particular dose is going to work for him or her. At that point, the patient will be following up with his or her physician to see if the dose needs to be adjusted.
With antidepressant therapy, it is also important for patients to understand that psychotherapy may be an integral part of their treatment. The therapist will help the patient understand what led to the depression, while also providing a realistic talking space to see if the medication is helping with the patient's depression.
Pharmacists play a crucial role when it comes to the effectiveness of a patient’s medication treatment regimen. As pharmacists, be on the lookout for patients being started on new antidepressant treatment regimens. You may be the difference as to whether the patient has a successful or not-so-successful medication treatment cycle.