Deprescribing in mental health: pragmatic steps for a better quality of life
Half of the UK population take at least one prescribed medicine, while a quarter take three or more. Polypharmacy has become increasingly common, with the average number of items prescribed per person per year in England having increased by 53.8% in the last decade. Patients are prescribed, and may continue taking, medicines that cause adverse effects and where the harm of the medicine outweighs the benefit. Adverse reactions to medicines are connected to 6.5% of hospital admissions. Patients admitted with one drug side effect are more than twice as likely to be admitted with another. Deprescribing is the optimisation of medication and is a vital part of improving outcomes, managing chronic conditions, and avoiding adverse effects. The goal of deprescribing is to lessen medication burden and enhance quality of life. This article presents case studies from clinical practice in a mental health service, and highlights the merits of specialist pharmacist-led interventions with respects to medication reviews and deprescribing.
Half (48%) of the UK population take at least one prescribed medicine, while a quarter (24%) take three or more prescribed medicines (Neave, 2017). In the UK, 17% of the population (7.3 million people) are prescribed an antidepressant, while 5% (2.9 million) are prescribed either a benzodiazepine or a z-drug (Public Health England, 2019).
Although prescribing rates are increasing, with the volume of prescription items dispensed in the last decade being 47% higher than the previous decade (Public Health England, 2019), rates of non-adherence remains high. In patients with depression, data of non-adherence varies between 40–80% (Mendis and Salas, 2003; Martin-Vazquez, 2017). In psychosis, up to 74% of service users who are prescribed antipsychotics discontinue their treatment within 18 months (Lieberman et al, 2005), although rates vary from 42% to 95% (Sendt et al, 2015). This may be related to the reported lack of choice and involvement in their treatment decisions (Goss et al, 2008; Morant et al, 2018). Studies also indicate that healthcare professionals may not be amply receptive of people's experiences and support requirements during periods of debating and managing antipsychotic cessation (Read, 2009; Salomon and Hamilton, 2013). This may result in people stopping medicines covertly, without support from their clinical team. At the same time as prescribing increases, one fifth of patients under mental services have not had a formal review in the last 12 months, and a quarter have not agreed what care they will receive with a clinician (Mental Health Taskforce, 2016).
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