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MDU advises on pitfalls of treating depression

The Medical Defence Union (MDU) has revealed it paid out nearly £3m in compensation on behalf of GP members to settle 30 claims arising from the treatment of patients with depression during a recent 10-year-period.

Examples of cases settled by the MDU include more than £1m paid out to a patient with a history of depression who was left severely brain damaged following an overdose after being prescribed the antimalarial drug mefloquine; over £21,000 paid out to a patient who became addicted to an antidepressant; and a GP who missed a fractured hip in an elderly patient with depression after he visited the doctor following a fall. The patient received over £6,500 in compensation.

In the latest edition of the MDU Journal, Professor Femi Oyebode, consultant psychiatrist and MDU Council member, highlights three main areas of risk when treating depressed patients:

  • Problems with medication
  • Failure to diagnose or treat an unrelated condition in a depressed patient
  • Failure to recognise the risk of suicide in a depressed patient.

The article includes advice for healthcare professionals on how to avoid such problems. While some of these points may seem obvious, they are all examples taken from the MDU's files:

  • Take care with prescriptions for drugs with similar names and with dosages, particularly with drugs that come in different formulae and strengths.
  • Beware of the risk of drug interactions, for example between lithium and diuretics.
  • Have a system in place to review patients on long-term medication.
  • Be aware of the current guidance on the prescription of antidepressants.
  • Ensure patients understand what is being prescribed and have been warned about the risks involved, any side-effects and alternatives to treatment.
  • All patients who present with depression need to be assessed regularly for risk of suicide.
  • Under shared care agreements, there should be a clear agreement on the responsibility for monitoring and treatment and the arrangements should be made clear to the patient.
  • Be prepared to refer patients for specialist treatment where necessary and have a system in place to track referrals.

Medical Defence Union