Case Study: HRT and Antidepressant Prescribing Review

Work Completed

150 female patients co-prescribed HRT and a first-line antidepressant were identified and reviewed.
Individual clinical assessments were conducted to determine appropriateness of dual therapy.
52 patients were excluded as not clinically appropriate for intervention.
97 patients were invited for a structured medication review with the Medicines Management Team.
Patients were contacted via SMS and offered consultations to consider deprescribing.
Additional support offered included referral to our Health Connections team, lifestyle advice, and our 6 week Habits for Health programme.

53 out of 97 patients (56%) reduced or stopped their antidepressant following review.
44 out of 97 patients (44%) declined intervention.
18 patients accepted referral for lifestyle and wellbeing support.
A proportion of patients were identified where symptoms may have been menopause-related or due to underlying physical health conditions rather than primary mental health diagnoses.

Menopausal symptoms can mimic anxiety and depression, therefore consider hormonal causes before initiating antidepressants.
Review ongoing need for antidepressants when HRT is started.
Holistic assessment (including blood tests where appropriate) is essential to rule out underlying conditions (e.g. thyroid dysfunction, B12 deficiency).
Medication reviews are key opportunities to identify deprescribing potential.
SMS invitations and structured reviews are effective tools for engaging patients.
Deprescribing contributes to both financial and environmental sustainability within the NHS.
This approach could be applied to other areas where antidepressants may be prescribed for alternative underlying causes.