Reviewing patients not ordering antidepressants (2025)

Hannage Brook Medical Centre

Project summary

Antidepressants are widely used medicines with approximately 15% of the population having at least one issue of these medicines in 2022.

NICE guidelines suggest that once started on antidepressants, patients should continue to take them for at least 6 months once well (or 12 months for generalised anxiety disorder). Shorter durations are associated with a higher risk of relapse. 
Patients often start on these medicines but do not continue due to side effects and / or resolution of symptoms.

When issuing prescriptions there are several safety prompts in place if a person is overordering their medication but if someone makes a decision to stop taking their medicine this is often not recognised given the lack of ongoing contact. 

In early 2024 a patient at the practice took their own life and this prompted a review of our follow up of patients who were taking antidepressants.

Our Pharmacy Technician undertook an audit of patients who had been prescribed antidepressants but failed to collect their ongoing medication as expected i.e. no prescription ordered for the last 84 days (our practice generally issues 56 day prescriptions). 

These patients were sent a message:
"We've noticed you haven’t collected your antidepressant prescription for a few months. It’s important to continue your treatment as prescribed, but you may have stopped it for a reason. Can you text back to let us know how you're getting on, particularly If you’re having any concerns or need to speak to someone about your mental health so we can support you."

Of those patients identified in the search (and two subsequent searches) approximately half of them (n= 52) received a text; the other patients (n=57) were already under review or it was clear in their notes why the medication had not been ordered.

Of the 52 patients who received the text we received responses from 36 (69%) patients. Over the 3 audits undertaken and responses received:

• 25% of patients had self weaned and were doing well
• 21% replied that they had enough medication and were continuing to take
• 17% ordered their medication or booked an appointment on receipt of the text
• 6% of patients were followed up after their response indicated they were struggling

The remaining 31% of patients did not reply and a message was sent to the most appropriate GP to follow these patients up. 

Feedback from patients and clinicians was positive with a commitment to continue this work every 2 months.

As part of running the project we noted that documentation at the time of starting antidepressants was often poor particularly relating to side effects and not to discontinue their medication without discussion with a clinician.

Our GP registrar fed back results from a further audit looking at this and a patient information leaflet was produced.