As a nurse in the antidepressant 2.0 era, I'm teaching my patients to cut down their doses using jewelry scales

This as-told-to essay is based on a conversation with Kristen Massingill, a 36-year-old nurse practitioner working in psychiatry.

I've worked in healthcare for over 15 years. I started my career in the ER, and spent a long time working there, but I've also worked in hospice, palliative care, and electrophysiology.

My main focus right now is working with patients on de-prescribing and discontinuing antidepressants. It's not something we're taught much about in nursing school.

I first got interested in de-prescribing when I was working with a couple of patients in the clinic who were really having a hard time getting off their medications. I thought, "There's got to be a way to do this."

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I've learned all about how to draw down dosages of different medications, sometimes going as far as weighing the drugs with jewelry scales. Some medicines, especially SNRIs (serotonin and norepinephrine reuptake inhibitors), are really challenging to taper, but you can do bean weighing, breaking open the capsules, and measuring out smaller doses of the medication.

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I'm always learning more about de-prescribing. We'll have rounds with the other practitioners each week where we'll discuss interesting cases. I've learned so much about tapering that way, in addition to the more formal education I got from Mark Horowitz.

A lot of what I do during the sessions is cheer on my patients. I have about a hundred total, but I get a lot more time with my patients than most practices offer. If it's a first evaluation, we'll spend up to an hour together. If it's a follow-up, we'll usually sit down together for 30 minutes or so, reassessing how things are going, and whether we need to slow down or speed up the tapering. I do a lot more patient education than I used to, and a big part of my job is encouraging people and figuring out how best to support them through the process.

Oftentimes, what's challenging is that these patients are tapering and they're doing such a great job and tolerating the taper really, really well. So they want to speed it up, because they want to be done, but they also know that that is not a great approach — they've often tried that in the past and failed. Most of the people I work with have tried to come off their antidepressant medication before and had a hard time, and they're very nervous about trying again because they had such a bad experience.

Of course, tapering isn't right for everyone, and we do have to turn some patients away, but even from them, I hear constantly during evaluations that they appreciate finally feeling heard.