Discussing antidepressants
Okay, this seems like it should be a straight forward thing that any psychiatrist, resident, or even med student can do.
Make a medication recommendation. Check. Discuss most likely potential side effects. Check.
Provide education about treatment of depression and goals of hospitalization (it takes weeks to months for full benefit, it may not be the right med and she may need to switch, it may be only partially effective and she may need to augment, she should increase frequency of therapy, she is not going to be perfect when she discharges, goals for discharge is tolerating the med, being safe, and having appropriate post hospital support in place, etc) in setting of first antidepressant trial and patient views it as “a last hail mary” and I don’t want her to be become discouraged and not take it long enough or not do other med trials if it is ineffective. But, ultimately, she wound up in tears and I feel like I really messed this up.
Tbf, I work inpt on a unit primarily with mania and psychosis. If I get a depressed patient it is usually someone on track for ECT. But the unit that this pt would ordinarily have gone to was completely full. So she wound up with me.
How should I have handled this?
ETA: At this point I am now 100% sure that I messed something up with her because I seemingly can’t even convey here, amongst peers, what the issue was. At this point I am just typing the same thing over and over in response. And I would love to know how I could have communicated the issue here, in this post, better. But I will try to rephrase to make it more clear.
It was about the fact that it will take weeks to months to see full benefit. And that it might require more than one med trial. It might require augmentation. And that she will likely still feel like crap when she leaves the hospital. And that it is not as simple as okay, let’s start this and you will feel better in a week.
So it was definitely a conversation that needed to happen. Because otherwise, when she didn’t see the results that she was expecting, she was likely to just stop the med. And unlikely to try again.
But I feel like the way I went about it wasn’t great. But I don’t know how I could have done it any better