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[e-drug] How Community Pharmacists can Help Patients on Antidepressants

E-DRUG: How Community Pharmacists can Help Patients on Antidepressants

Dear All,

Sharing a letter to the editor of Journal of Pharmacy Practice and Community 
  - How Community Pharmacists can Help Patients on Antidepressants at Risk for 
Suicides and Sexual Dysfunction - 

Widespread use of antidepressant drugs has led to suicidal attempts and
sexual dysfunction among adolescent psychiatric patients.[1] 
Patients usually complain of delayed ejaculation and libido loss with the SSRIs 
specifically. [2] In premature ejaculation these drugs have a significant 
impact, and they are risky for many patients if they are not well aware of 
their considerable side effects.   Adolescents are more commonly the victims of 
side effects.  Non-compliance and drug denial may ultimately result in 
behavioural disorders and even suicidal  intents.[3]  The mortality rate of 
adolescents with depression is contributed to by these side effects. 

Educating patients and their relatives regarding these potential side effects 
is very necessary and can be done by the pharmacist.[4] 

The foremost culprits for adolescent mortality were tricyclic and SSRI use in 
the US.[2,4], so application of appropriate counselling is needed alongside 
prescription of these drugs.[5-6] 

In under-developed areas like Peshawar, sexual dysfunction in male teenagers
is considered a 'felony' or against customs, and an ethics issues. So
patients mostly prefer to hide such problems or hesitate to share concerns with
parents. Patients may be tormented, tortured and laughed at, if they share
such issue with someone. So depressed teenagers who are hospitalized
or kept in rehabilitation centers can be actual targets. They can suffer a lot 
as they do not have enough courage to unveil their condition. 

To avoid these matters, appropriate counseling and knowledge regarding health, 
disease, treatment and therapeutic outcomes should be encouraged for such 
patients .[7]     The Community Pharmacist can have a major role in educating 
the patient and the family members about the undesired effects of, for example, 
venlafaxine, which can help avoid further patient depression and fear. 

We believe, In this regard, the following steps should be followed:

- the patients should be completely educated about their condition so that they
worry less.

-  Patients should be well aware of the therapy and its aims so that they 
cooperate better throughout the therapy and show good adherence to the 

- Patients should be fully informed about the undesired side effects of the 
drugs to avoid any additive stress, depression or confusion.

- In case of married victims, the couple should be well informed and
counselled to avoid any disturbance in their martial relations. The patient's 
should be educated to cooperate with the course or therapy.

Physicians may not be able to conduct these guidance sessions
due to shortage of time, and the role of the community
pharmacist is very important to educate the patients enough to diminish the 
risks of
non-suicidal self-damage and suicidal intention, especially among the 
The counselling will also contribute towards improved quality of life and make 
the treatment more effective and efficient.

1. Outhof K. Antidepressant-induced sexual dysfunction. SA Fam Pract.

2. Kyoung-UL, Young ML, Ji-Min N, Hae-Kook L, Yong-SilKweon, Chung
TL, et al. Antidepressant-Induced Sexual Dysfunction among Newer
Antidepressants in a Naturalistic Setting. Psychiatry Investigations.

3. Brent DA. Antidepressants and pediatric depression: the risk of doing 
N Engl J Med. 2004;351(16):1598-601.

4. Tarek AH, Thomas L, Judith R. Suicidality in pediatric patients treated with
antidepressant drugs. Arch Gen Psychiatry. 2006;63(3):332-9.

5. Rafi MS, Naqvi SBS, Khan MU, Fayyaz M, Ashraf N, Dhingra S. Evaluation
of Potential Drug-Drug Interactions with Antidepressants in Two Tertiary Care
Hospitals. JCDR. 2015;9(7):FC05.

6. Findings of a retrospective study on factors responsible for depression in a
Northern Indian State. JMOOD. 2014;4(1):1-6.

7. Dhingra S, Parle M. Non-drug strategies in the management of depression:
acomprehensive study of systematic review and meta-analysis of randomized
controlledtrials. J Neuro Behavio Healt. 2011;3(5);66-73.

Best Regards,
Akram Ahmad, PharmD, BPharm
Department of Clinical Pharmacy,
UCSI University, Kuala Lumpur, Malaysia
Journal of Pharmacy Practice and Community Medicine (www.jppcm.org)
"akram ahmad" <akrampharma67@gmail.com>
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