SSRI counselling

Question 1

Structure to the consultation for SSRI counselling

Answer 1

Brief Hx
Check understanding of the medication and condition

Invite concerns and questions about the medication

Check for contraindications - suicidal risk, mania

Provide knowledge - ATHLETICS

Provide SN advice

Mention leaflet and follow up

Question 2

Important aspects to any GP history

Answer 2

Offer to examine (if relevant to the station)

SN
Follow-up
Leaflet

Question 3

Explanation of SSRIs - layman terms

Answer 3

In depression/anxiety there is often an imbalance of chemicals in the brain including serotonin

This medication works to allow the body to rebalance the levels of serotonin in the brain

Question 4

Contraindications for SSRIs

Answer 4

Mania

QTc prolongation

Question 5

ATHLETICS of SSRIs

Answer 5

Action - works to rebalance levels of chemicals in the brain

Timeline/How to take - once daily tablet

Length - until 6m after recovery

Effects - in 4-8w

Tests - no monitoring needed

Important side effects - GI (diarrhoea, N+V), appetite and weight change, headache, increased anxiety and suicidal ideation for first two weeks

Supplementary advice - SN about suicidal ideation and serotonin syndrome

Question 6

Supplementary /SN advice to give for SSRIs

Answer 6

Important not to stop suddenly as there is a risk of withdrawal symptoms - we need to slowly reduce it so your body can adjust to the change

If you find you are confused, agitated with potential diarrhoea - stop taking the medication and seek urgent medical advice because this may be a sign the serotonin in your brain has become too high

If suicidal ideation - please urgently contact GP or Samaritan’s

Follow up in 1w

Leaflet and online resources