Psych CASC / OSCE · Psychopharmacology — antidepressants
Explaining antidepressant start, side-effects and review plan (CASC)
CASC-style communication station: shared decision on starting an SSRI/SNRI, early monitoring, sexual SE, suicide risk framing, and STAR*D-informed next steps if nonresponse.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 29-year-old with moderate-severe unipolar depression agrees to medication but fears 'personality change', addiction, sexual side-effects, and suicide risk from the black-box warning they read online. Partner is in the room and asks how soon it works and what happens if the first tablet fails.
Station instructions (candidate)
You have 7 minutes. Explain recommended antidepressant treatment for moderate-severe unipolar depression to the patient and partner. Cover expected benefits and time course, common side-effects including sexual dysfunction, early suicide-risk monitoring without scaremongering, addiction myths, and what happens if the first medicine is not enough. Avoid jargon without explanation. Do not guarantee cure. Anchor in evidence-informed stepped care.[1][6]
References6ShowHide
- [1]Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis Lancet, 2018.PMID 29477251
- [2]Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report Am J Psychiatry, 2006.PMID 17074942
- [3]Montejo AL, Llorca G, Izquierdo JA, et al. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients J Clin Psychiatry, 2001.PMID 11229449
- [4]Stone M, Laughren T, Jones ML, et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration BMJ, 2009.PMID 19671933
- [5]Geddes JR, Carney SM, Davies C, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review Lancet, 2003.PMID 12606176
- [6]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391