Quality prescribing for antidepressants: guide for improvement 2024 to 2027

Clinical foreword

We are delighted to present the Quality Prescribing for Antidepressants guide. This guide is welcomed as an opportunity to further improve the care of individuals receiving antidepressant medication and promote a holistic approach to person-centred care. It recommends supportive and collaborative discussions between individuals and prescribers when reviewing antidepressants, as well as highlighting the importance of addressing health inequalities and wider climate and sustainability challenges. The recommendations are aimed at supporting people receiving antidepressants, healthcare professionals, general practice clusters, health boards and health and social care partnerships and are designed to support improvements in healthcare service redesign and provision of care.

The prescribing of antidepressants continues to increase in Scotland, with many people receiving antidepressants for two years or more. This may be appropriate for some individuals, but it is important that ongoing treatment is reviewed regularly and that the risks and benefits of treatment are discussed. Treatment goals should be agreed with individuals, both at the time of initiation and when reviewing medication, and treatment plans should take a holistic approach to management and support. These should include discussions of non-pharmacological and wider community support options where these are available and indicated.

This prescribing advice is primarily intended to support and encourage the appropriate use of antidepressants for mental health and physical conditions, as part of the wider treatment options available. It supports appropriate initiation of antidepressants, regular and proactive reviews, reduction and stopping of treatment where it is ineffective or where treatment courses have been completed. Regular person-centred reviews can optimise the care of those receiving antidepressants and minimise avoidable medicine-related harm. These reviews can also support and enable appropriate continuation of antidepressant treatment where this is required, using the 7-Steps person-centred review approach.

This guide aims to maximise benefit and ensure safe, appropriate care from antidepressants. It is not intended to override other pharmacological or non-pharmacological prescribing treatment advice such as NICE, British Association for Psychopharmacology (BAP), Scottish Government Polypharmacy guidance or the principles outlined in the Realising Realistic Medicine report. It is intended to complement these and add practical advice for tailoring care to the needs and preferences of the individual.

This guide has been developed with a multidisciplinary team across Scotland, with clinical and policy expertise from NHS Scotland and Scottish Government and with experts by lived experience and patient groups.

We are extremely grateful to all those who contributed to the working group, the review and development of this guide.

Alastair Cook
Principal Medical Officer Psychiatric
Adviser
Scottish Government

Alpana Mair
Head of Effective Prescribing and Therapeutics
Scottish Government

Professor Sir Gregor Smith
Chief Medical Officer for Scotland

Alison Strath
Chief Pharmaceutical Officer