A Disclosure of Depression and a Request to Stop Medication
Priya is 41 and came to you five sessions ago for chronic low-back pain. Today she discloses that she has moderate depression, has been on escitalopram 10 mg for a year, and sees a psychiatrist monthly. She asks you to design a yoga plan so that she can stop the tablets within two months, and says she has not told her psychiatrist that she is doing yoga. She also reports sleeping about four hours a night and asks you not to tell anyone what she has told you. You are a certified yoga professional working in a studio, not a clinician.
1. How do you respond to her request, and what do you say about confidentiality? Give the reasoning behind your boundary.
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The boundary and why
- Medication decisions - starting, tapering or stopping - belong to her psychiatrist. Escitalopram discontinuation without a taper plan carries withdrawal effects, and relapse risk is real; I have no clinical training, no access to her history, and no ability to monitor her.
- I can offer yoga as a supportive practice alongside treatment. I cannot offer it as a substitute, and I will not design a plan framed around stopping medication.
Words 'I'm glad you told me, and I want to be clear about what I can and can't do. I can build you a practice that supports sleep, stress and mood. I can't advise you on your tablets or plan for you to come off them - that has to be your psychiatrist's decision. What I'd encourage is telling them you're doing yoga, so it sits inside your treatment rather than outside it.'
Confidentiality Explain honestly: what she shares stays private, and I will not discuss it with other students or staff who are not involved in her care. There are limits - if I believed there was a serious risk to her safety or someone else's, I would have to act on it, and I would tell her first. Do not promise absolute secrecy; promise discretion and explain the exception.
Also flag: four hours' sleep and not telling her treating clinician are both reasons to encourage contact with her psychiatrist sooner rather than later. If she expressed hopelessness or thoughts of self-harm, the response would change to an immediate safety conversation and referral.
2. What goes into the yoga plan you do offer, and how do you coordinate with her psychiatrist?
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The plan (6 weeks, reviewed at week 3)
- 4–5 short sessions a week, 20–25 minutes, plus one longer restorative session. Short and repeatable beats ambitious and abandoned.
- Gentle asana with props: seated side bends, cat-cow, supported bridge, legs-up-the-wall, supine twist with a bolster, gentle standing sequences - chosen so low-back pain is not provoked.
- Breathing: extended exhale, bhramari, and a simple 1:2 count, seated, 5 minutes; no forceful practices and nothing stimulating late in the evening.
- Yoga nidra or a guided body scan of 15–20 minutes in the evening, aimed at the sleep problem she has described.
- A brief daily log: hours slept, mood (simple 1–5 rating), back pain 0–10, whether practice happened.
- Sleep hygiene pointers as general lifestyle information, not as clinical advice.
Coordination
- Ask her to sign a short consent allowing me to send her psychiatrist a one-page summary: what she is doing, how often, what I am not doing, and a request for any guidance or restriction. Offer to draft it so it is easy for her to hand over.
- Do not contact the psychiatrist without written consent, and share only what is relevant to yoga - not her account of the sessions in detail.
- Make no predictions about symptom change, and state in the plan that it is adjunctive.
3. What do you write in the record, what do you deliberately leave out, and how do you store it?
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Record (same day, factual and time-stamped)
- Date and session number; that she disclosed a diagnosis of moderate depression and current escitalopram 10 mg, prescribed by a psychiatrist she sees monthly.
- Her request, in her words: a plan to stop the tablets within two months.
- My response: declined to advise on medication, explained the scope boundary, offered yoga as adjunctive support.
- The confidentiality explanation I gave, including its limits.
- Consent status for contacting her psychiatrist (signed/declined), and the referral or coordination action taken, with a copy of any letter.
- The plan issued: practices, frequency, review date, outcome measures to collect.
- Advice given: raise yoga with her psychiatrist, and raise the four-hour sleep pattern.
- Any risk indicators observed and what was done about them.
Deliberately not recorded
- Speculative diagnosis, interpretation of her mental state, or anything she said in confidence that is not relevant to her yoga plan.
- Opinions about her medication or her psychiatrist.
- A promise of any outcome.
Storage and sharing Keep it in a locked cabinet or a password-protected file with access limited to those delivering her sessions. Do not name her or her condition in class, in WhatsApp groups with students, or in marketing. Share with the psychiatrist only what the signed consent covers. Know the retention period your studio uses and follow it; give her a copy of her plan if she asks.