Antidepressant counselling


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a junior doctor in general practice.

Patient: This patient has been prescribed an antidepressant by the GP for low mood.

Task:

  • The patient has come back to the surgery with some questions they would like answering before starting an antidepressant.
  • Answer all questions the patient may have.
  • After 6 minutes you will be asked a series of questions by the examiner.

Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

Questions

  1. How long will it take for them to start working?
  2. How often do I take them? For how long for?
  3. Are antidepressants addictive? (If candidate answers no – ask why the dose needs to be increased)
  4. What are the common side effects experienced with antidepressants?
  5. Can I just stop taking them if I don’t like them?
  6. What other treatments are there for depression?

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school, year or grade
Clarifies who they are talking to
Asks patient for preferred name


How long will it take for them to start working?
Gradual effect over 2-4 weeks


How often do I take them? For how long for?
Tablet is taken once a day
For a first presentation, taken for 6-9 months


Are antidepressants addictive? (If candidate answers no – ask why the dose needs to be increased)
No
Dose does not always work at low dose; some patients need dose increased to experience therapeutic benefit


What are the common side effects experienced with antidepressants?
Headache
GI bleeds
Abdominal pain
Constipation
Diarrhea
Dyspepsia
Nausea and vomiting
Sexual dysfunction
Hyponatremia


Can I just stop taking them if I don’t like them?
No
Need to be gradually reduced over time
Side effects if you suddenly stop taking them


ICEF
Explores ideas, concerns, expectations, feelings
Asks patient if they have any questions


Question What lifestyle advise can be beneficial in depression?
Exercise
Reducing alcohol intake
Meditation
Sleep hygiene
Stress management


Question What are the different classes of antidepressants?
SSRI (Selective Serotonin Reuptake Inhibitor)
MAOIs (Monoamine Oxidase Inhibitors)
TCAs (Tricyclic Antidepressant)
SNRIs (serotonin-norepinephrine reuptake inhibitor)


Question What are the symptoms of discontinuation syndrome if antidepressants are suddenly stopped?
Flu like symptoms
Electric shocks
GI disturbances
Anxiety
Sleep disturbances



Score