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Introduction

Jason comes back for a follow-up appointment. He has not been taking the Zolpac, and is depressed.

(The story so far...)

Jason has been taking an antidepressant for some time but it was taken off the market because of concerns about suicide risk. Two weeks ago he saw Dr Williams and reluctantly agreed to try the NICE recommended treatment, Zolpac.

Dr Williams

Dr Williams

From what you've said I don't think carrying on without any medication can be in your best interests. I looked into the US drug and found out that it is licensed in the UK, but not for treating depression. Quite honestly Jason, I think that Zolpac is your best option for the time being - at least until more trials have been carried out on the US drug.

Jason

Jason

But you can prescribe the US drug for me off-licence can't you? I've had depression for so long now and I've tried so many different drugs, I honestly think I know as well as you do what works and what doesn't.

What should the doctor do...? (Select A,B or C)

A

Prescribe the US drug for Jason off-licence and monitor his reaction carefully, even though she thinks Zolpac would be better for him?

B

Prescribe the US drug for Jason off-licence as he clearly won't take Zolpac and it's ultimately his decision?

C

Explain again why she thinks Zolpac is in his best clinical interests?

Dr Williams

See what the doctor did

Dr Williams is concerned about Jason's non-compliance. She wants him to use his knowledge about his condition in making decisions but still feels that Zolpac is the best option for him. She encourages him to talk about his concerns and they discuss ways of dealing with an increase in anxiety should it arise.

References

In providing clinical care you must:
a. prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient's health, and are satisfied that the drugs or treatment serve the patient's needs12 20
b. provide effective treatments based on the best available evidence (Good Medical Practice paragraph 16)

You must support patients in caring for themselves to empower them to improve and maintain their health. (Good Medical Practice paragraph 51)