A Tiny Ripple Of Hope

Behind The Counter | 02 | Small spark, big change.

Jan 10, 2025

Welcome back to another edition of Behind The Counter. My ongoing series where I share short stories from my patient interactions, offering a glimpse into my world behind the pharmacy counter as I attempt to help my patients navigate the complex ~~sick-care~~ healthcare system — not by pushing pills, but by dispensing a dose of humor, hope, and insight.

Today I want to share one of my first success stories in antidepressant deprescribing.

Meet my patient, Abdul (not his real name). Exactly a year ago he found himself ceaselessly exhausted, overwhelmed, and stressed; the pressures of juggling his marriage, career, and responsibilities as a Father of four reached a turning point.

He turned to his family doctor for help, who prescribed him Effexor 75mg (chemical name: Venlafaxine), to be taken once daily for anxiety. He obliged and took the script.

water ripple — Photo by Linus Nylund on Unsplash

Flipping The Script

When Abdul picked up his initial prescription, I was absent and didn’t get a chance to speak with him. Three months later, it was time for his refill. While preparing his medicine, I noticed his age and otherwise solid medical history and decided to flag his medication bag, ensuring I’d get the chance to speak with him at pick-up.

Now, typically in these situations, most pharmacy staff won’t engage the patient. It’s a refill, the person has had it before and probably doesn’t have any burning questions.

However, I decided to flip the script. I pulled Abdul aside and asked him a series of questions that no other pharmacist would think of. My goal was to put Abdul in the driver's seat — as opposed to just following the typical orders: take with food, follow up in 3 months, rinse and repeat.

During our conversation, I dug deeper to try and understand what was it about his anxiety and stress that led him to this point. The specific challenges he was facing as a busy professional and Father of four. What strategies (if any) did he have in place to help him cope with his overwhelming stress? Most importantly, how did he feel since starting his medication — has he noticed any changes or improvements?

“The quality of your life is determined by the quality of the questions you ask.”

— Tony Robbins

Asking The Burning Question

During our discussion, Abdul emphasized his struggle with the side effects of Venlafaxine. His fatigue was worsening. Low affect and emotional numbness began to creep in. It felt as if the “volume had been turned down,” not just for his negative emotions, but positive emotions as well.

Antidepressants can take away the crushing lows of depression, or help tame the monkey-mind that generates constant thoughts and anxiety. But they can also rob you of the blissful highs and emotional swings that make our everyday lives worth living.

I decided to probe a bit more into the emotional blunting he was experiencing, remembering he has 4 children. It was clear that it began to weigh on him how he wasn’t fully present when he was around them.

We reflected on the challenges of modern-day parenting. The pressures of making ends meet, while attempting to provide a good life for our families. The difficult days and sleepless nights. Until I thought to ask.

How would you want your children to feel, at your age? Imagine when they’re in their 30s, what do you want for them?

The question struck a nerve with Abdul, and the answer was obvious. In that moment he decided it was time for him to reflect and reconsider his approach to mental health.

A Tiny Ripple Of Hope

I didn’t have to do much to help him realize that the solution to his problems wouldn’t be discovered at the bottom of his pill bottle.

After our conversation, he decided to stop the medicine and elected to go with a more sustainable approach to improving his mental health. We discussed strategies and tools rooted in physical exercise, mindfulness, and spirituality. Abdul shared with me that he is a man of faith. I encouraged him to rediscover some of the lessons and teachings from his religion, to lean on in moments of stress or anxiety.

Nine months after he stopped taking Venlafaxine, he’s exercising more frequently. He’s leaning on his faith and has discovered a new sense of optimism and hope.

Last time we spoke, he stated how these small changes have drastically improved all aspects of his life, from his health and work to his family life.

“These people moved the world, and so can we all. Few will have the greatness to bend history; but each of us can work to change a small portion of the events, and in the total of all these acts will be written the history of this generation…”

“It is from numberless diverse acts of courage and belief that human history is shaped. Each time a person stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, they send forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance.”

— Robert F. Kennedy Sr | Day of Affirmation Address. June 6, 1966.

When I first started my deprescribing journey, I had ambitious goals and intentions. Lost in the trappings of entrepreneurship, start-up culture, and making it in the competitive landscapes of writing and podcasting, I decided that I would consider my venture a success if I could help one patient reduce their reliance on medicine.

For the above case, all it took was a single conversation, ignited by a pharmacist who took a chance and approached his patient with courage, curiosity, and compassion. That produced a rippling effect that has gone on to positively impact not just one individual, but his family, colleagues, and friends.

One successful case closed. Many more to go.

Thank you, Abdul, for your trust. I’m grateful for the friendship we’ve developed, and I wish you luck in your next chapter.

Thanks for reading. Much Love.

“The true worth of an action is not measured by its success or failure, but by the motivation behind it

—The Dali Lama

A challenge for all the community pharmacists out there. Any time you dispense an antidepressant — whether it’s a refill or a new script — have a real conversation with the person in front of you. Try and understand their world. Their struggles. Map out their relationship with their medicine. Ask a hard question. Don’t underestimate the impact you can have. Good luck!