Putting caring conversations into practice

Below is my published response to this open question by Dr Derek Summerfield's: NHS antidepressant prescribing: what do we get for £266m a year?

I will not be alone in feeling unable to answer the question that Summerfield poses. I agree with Professor Lawrie that “the remaining questions about the use [of antidepressants] should be addressed in clinical trials”. It is more than half a century since antidepressants were first prescribed, yet we rely (in terms of evidence base), on studies confined to short term efficacy (average 8 weeks). Given that most of those who continue on antidepressants do so in the long-term or indefinitely, I consider that it is appalling that such an important aspect, vital to informed consent, continues to be a “remaining question”.

In our approach to “remaining questions” such as this, it is vital that we listen to the experience of those taking antidepressants, and that we do so in a way where we do not judge that experience: whether it may be good, bad or ugly.

Arriving at work this morning I was invited to “Putting Caring Conversations into Practice” a resource funded by the Scottish Government and developed by Scottish charity Waverley Care. This resource aims “to break down barriers than can exist between patients and healthcare professionals, encouraging open and honest conversations which achieve positive outcomes for both parties.”

In the weeks that have followed since the release of the Lancet meta-analysis by Cipriani et al, (5) professional use of language has often “deployed” military and criminal metaphors, such as: “war on antidepressants”, “war on depression”, “pill shamers”, “villains” and “demonisers”. Such language, in my opinion, should have no place in our shared aspiration for wellbeing and is likely to “marshal” ongoing antisyzygy.

Let us hope that in terms of antidepressant prescribing, and the ongoing need to learn about experience beyond the short-term, that we can all be part of caring conversations .

 

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