A patient who has been taking an antidepressant for 2 months shares with the nurse, "Since my depression is over, I've stopped the Prozac and I won't need to see you any longer.". Which response by a nurse would be most therapeutic?

Question

a. "Do you recall that we discussed the need for you to take the medication for up to 1 year before trying to taper off the drug? Let's discuss why it's not advisable to stop your medication abruptly.".
b. "It is not recommended that you stop the antidepressants abruptly. I strongly suggest that you continue seeing me regularly to ensure that any change in your condition will be treated immediately.".
c. "You should not discontinue your medication without consulting your psychiatrist. You will very likely experience withdrawal symptoms and become more depressed than you were before.".
d. "Although it isn't wise to stop the medication as you have, you seem to be handling things very well. Call me if you have any questions and follow-up with your psychiatrist in a year.".

Answer 1

A
Most patients who respond initially to antidepressant therapy require at least 1 year of therapy and may take medication on a lifetime basis. This is similar to patients who take antihypertensives or insulin. The patient's statement alerts the nurse to set clear therapy goals that extend beyond medication assessment. Prozac takes 2 to 4 weeks to reach a steady state and is maintained in the body for several weeks after it is discontinued, but the nurse's suggestion of tapering off the medication is a wise intervention for this patient, who seems impulsive about medication adherence. A patient with a knowledge deficit and nonadherence potential requires communication that recalls prior teaching and that builds on the knowledge he or she already has. Reminding the patient of the time it takes to become depressed provides anticipatory guidance about the possibility of needing medication on a lifetime basis. Sarcastic humor is usually a poor response that demeans the patient and may reflect the nurse's impatience and a judgmental attitude toward the patient, and a laissez-faire response does not reflect a caring attitude. Withdrawal usually is not a problem for medications with a long half-life.