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Depots always involve a painful ethical labyrinth. They are deployed
when there is fear of undesirable non- compliance. They imply a fracturing
of trust between the patient and the consultant.
One of the difficulties with depots is that they provide a much more
limited choice in comparison with the oral alternatives. There are only
six depot anti- psychotics, and five of these are first generation
'typicals', including clopixol and depixol. The sole atypical as a depot
is risperidone (1). Depots are usually older drugs, then, and these can
precipitate movement disorders and also chronic weight gain (the newer
drugs may alas be ultimately no better).
Assertive Outreach Teams (AOTs) deal with difficult patients.
Nowadays, AOTs have Community Treatment Orders (CTOs) to force would- be
rebels to accept their depots. The tangled psychiatric path is never going
to be easy and straight. In the context of CTOs, a study that bribes
patients to take depots is perhaps irrelevant, and certainly it is
ethically dubious. Mixing up money with medicine is a dangerous dead- end.
(1) The Maudsley Prescribing Guidelines. 9th Edition. Pgs. 42- 49.