Prescribing in mental health

Many of us are aware of the unique challenges that mental health consultations can bring. Decisions relating to prescribing for patients with anxiety or depressive disorders can be some of the most difficult we face in our day-to-day work, especially those of us that have stepped away from emergency healthcare. Health Education England (HEE) acknowledges the complications associated with prescribing antidepressant or anxiolytic medication effectively and have, alongside the Royal Pharmaceutical Society (RPS), published a competency framework to support clinicians' development (HEE, 2020). This document highlights the importance of prescribing safely and professionally, using a joint decision-making process. For us to support our patients—especially those in distress or crisis—to make an informed choice, there is a need for us to be confident in our understanding of the pharmacological, psychological, and sociological aspects that may influence patient and clinician alike.

The present article focuses on adult patients as paediatric mental health is a complex field which should be initially dealt with by specialist services. The use of fluoxetine, the only antidepressant deemed appropriate for children, should be initiated by a child psychologist (National Institute for Health and Care Excellence (NICE), 2019). Similarly, more complex conditions, such as bipolar disorder, should be managed by specialists in the first instance.