Psych patient refuses medication but can't tell me why...what now?

[Marshall1]

I have a patient who has been diagnosed with clinical depression and anxiety, understands the diagnosis, is alert, oriented and otherwise reasonable in demeanor but absolutely flat out refuses to take an antidepressant to help themselves. I've asked this person why they won't (side effect concerns? cost?) and this patient cannot tell me why other than "everything I read about them says they don't work or is negative and I do have good days here and there." This patient is not trying to be difficult, attention seeking by non-compliance - he really does not know why he is so opposed except the basis of what he has read on the internet or in magazines. He even admitted he knows people who have been or are on SSRI's or SNRI's that have been helped by them. Before seeking treatment he said he used over the counter and natural type products but things just got worse. I don't know how to get through to him or even if I can. I've told him more people are likely to write about a negative experience than a positive one and studies have shown the medications are effective but he continues to refuse. Any suggestions?

[Meriwhen, ASN, BSN, MSN, RN]

It may be a sexual issue, meaning with SSRs, it decreases or can cause a person not to orgasam.

Possibly. That's one of the reasons patients are not usually very forthcoming with sharing. There are ways to minimize/eliminate sexual issues though...but only if the prescriber knows about the issue in the first place.

Regardless, it's a a valid reason for them to refuse. Almost any reason a patient gives will be valid, right down "I just don't want to take it and that's that." They don't need to explain the why or how justifying it.

Doesn't mean the nurse shouldn't continue trying to educate the patient, because they should continue to educate. But refusal shouldn't be looked at as a test with a "right" or "wrong" answer.