Explaining antidepressant start, side-effects and review plan (CASC)

Station instructions (candidate)

You have 7 minutes. Explain recommended antidepressant treatment for moderate-severe unipolar depression to the patient and partner. Cover expected benefits and time course, common side-effects including sexual dysfunction, early suicide-risk monitoring without scaremongering, addiction myths, and what happens if the first medicine is not enough. Avoid jargon without explanation. Do not guarantee cure. Anchor in evidence-informed stepped care.[1][6]

Marking domains

Mark empathy and agenda setting; accurate plain-language mechanism (monoamine modulation helping mood circuits, not a “personality drug”); honest sexual side-effect discussion grounded in high real-world rates; early review plan for activation/suicidality; clear follow-up and safety-net; STAR*D-style message that many people need a second step and that is not personal failure; no over-promise and no stigma.[2][3][4]

Model communication map

1. Open: thank them; check what they have read; name shared goals (sleep, energy, hope, work/relationships).[6]
2. Medicine role: reduces depressive syndrome intensity for many people; works best with psychological and social supports, not instead of them. Network evidence supports antidepressants as a class over placebo in adult MDD.[1]
3. Choice example: e.g. sertraline starting 50 mg orally daily, with a plan to review and titrate; explain why this agent fits anxiety-depression overlap if relevant.[1][6]
4. Time course: some sleep/anxiety change earlier; mood often needs weeks; full trial typically several weeks at an adequate dose before judging failure.[2]
5. Sexual SE: common with many serotonergic medicines — we will ask proactively; options include dose adjust, switch, or different class if needed.[3]
6. Suicide risk framing: untreated depression raises risk; early weeks after starting need closer contact because a minority experience worsening ideation or agitation — safety plan, crisis contacts, earlier review if worse.[4]
7. Addiction myth: not recreationally addictive like opioids; stopping should be planned because of discontinuation symptoms and relapse risk; continuation after improvement prevents relapse for many.[5]
8. If first fails: many people need a second step (switch or add-on) — sequential care is normal science, not blame.[2]
9. Close: questions, written info, who to call tonight if suicidal thoughts escalate.[6]

Common fails

• Promising zero side-effects or “you will feel normal in 48 hours.”
• Dismissing sexual dysfunction despite high documented incidence.[3]
• Either terrorising about black-box warnings or ignoring early monitoring needs.[4]
• Framing switch after nonresponse as rare catastrophe rather than expected sequential care.[2]
• Calling antidepressants “addictive” without distinguishing discontinuation from substance dependence.[5]