Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care

Bosman, Renske C.; Huijbregts, Klaas M.L.; Verhaak, Peter; Ruhé, Henricus G.; Marwijk, Harm van; Balkom, A.J.L.M. van; Batelaan, Neeltje M.

doi:10.3399/bjgp16x686641

Cited by 55 publications

(128 citation statements)

References 26 publications

Supporting

Mentioning

121

Contrasting

Unclassified

Order By: Relevance

“…Patients may interpret this as a relapse, where in fact a new disorder has arisen. In any case, fear of relapse has been identified as one of the most important factors preventing patients (and their doctors) from attempting discontinuation [13]. This makes profiling of the essence: which patients are most likely to relapse following discontinuation (or are at risk for postwithdrawal disorders)?…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, a chronic or recurrent course is common in both anxiety disorders and depression, and long-term antidepressant use is advised for this category of patients [1,5]. Secondly, antidepressants may not be discontinued because patients are afraid to do so [13], or because both general practitioners and patients do not take the initiative to discuss discontinuation [13]. Moreover, relapses following remission [14,15] and difficulties discontinuing antidepressants [16] may result in long-term antidepressant use.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term and Short-Term Antidepressant Use in General Practice: Data from a Large Cohort in the Netherlands

Huijbregts¹,

Hoogendoorn²,

Slottje

et al. 2017

Psychother Psychosom

View full text Add to dashboard Cite

Background: Antidepressant use is highly prevalent. Research has mainly focused on efficacy during short periods of use for depression and anxiety. There is a relative paucity of data regarding the frequency of long-term use. Methods: To determine the prevalence and possible increase of long-term use of antidepressants over recent years, we analyzed routine general practice care data in a large cohort of patients (n = 156,620) in and around Amsterdam, The Netherlands. Additionally, predictors of long-term use were studied. Results: Prevalence of long-term use of antidepressants is substantial, and such use appears to be increasing: 30.3% of use was long-term over the period 1995-2005 compared to 43.7% for the period 2005-2015. Higher age, a registered diagnosis of anxiety or depression, and the use of SSRIs or SNRIs were associated with long-term use in multivariate analysis. In addition, specific antidepressants were differentially associated with long-term use. Conclusions: Long-term antidepressant use is substantial and appears to be on the rise. Awareness of this phenomenon should be increased, such use should be prevented when possible, and reasons for long-term use need to be examined.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Term and Short-Term Antidepressant Use in General Practice: Data from a Large Cohort in the Netherlands

Huijbregts¹,

Hoogendoorn²,

Slottje

et al. 2017

Psychother Psychosom

View full text Add to dashboard Cite

show abstract

“…Of the three full papers assessed, two were excluded (no data on attitudes, beliefs, feelings, perceptions on continuing or discontinuing antidepressant use n=1, did not use qualitative data collection and analysis n=1). A total of 22 papers reporting 22 studies were therefore included in our review (Karp, 1993;Knudsen et al, 2002;Pollack and Grime, 2002;Hoogen, 2006;Verbeek-Heida and Mathot, 2006;Holt, 2007;Johnston et al, 2007;Leydon et al, 2007;Wilson, 2007;McMullen and Herman, 2009;Aselton, 2010;Dickinson et al, 2010;McKinney and Greenfield, 2010;Iden et al, 2011;Schofield et al, 2011;Buus et al, 2012;Bayliss and Holttum 2015;Eveleigh, 2015;Nygaard et al, 2015;Weaver, 2015;Bosman et al, 2016;Johnson et al, 2017). Of note, no potentially relevant titles and abstracts were excluded solely on the basis of being non-English language publications.…”

Section: Study Selectionmentioning

confidence: 99%

Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis

Maund

Dewar-Haggart

Williams

et al. 2019

Journal of Affective Disorders

View full text Add to dashboard Cite

show abstract

“…The increasingly long-term use of SSRIs -with nearly half of patients in the UK taking antidepressants for more than two years 24,25 -arises in part because patients are unwilling to stop due to the aversive nature of the withdrawal syndrome 24,26 , and a lack of information on how to mitigate the syndrome 24,26 . Doctors feel that there is not enough guidance on how to proceed with discontinuation 24 .…”

mentioning

confidence: 99%

Tapering of SSRI treatment to mitigate withdrawal symptoms

Horowitz

Taylor

2019

The Lancet Psychiatry

192

226

View full text Add to dashboard Cite

All antidepressant classes are associated with a withdrawal syndrome. SSRI withdrawal syndrome occurs often and can be severe, and may compel patients to re-commence their medication. Although the withdrawal syndrome can be differentiated from recurrence of the underlying disorder, it may also be mistaken for recurrence, leading to long-term unnecessary medication. Authorities currently recommend short tapers, of between two to four weeks, down to therapeutic minimum, or half minimum doses before complete cessation. Studies have demonstrated that these tapers show minimal benefit over abrupt discontinuation, and are often not tolerated by patients. Tapers over months and down to doses significantly lower than minimum therapeutic doses have shown greater success rates. Other medications associated with withdrawal symptoms are tapered to reduce their biological effect at receptors by fixed amounts in order to minimise withdrawal effects. These are exponential tapering programmes which reduce to very small doses. We examined the PET imaging data of serotonin transporter occupancy by SSRIs to demonstrate that hyperbolically reducing doses of SSRI will reduce their effect on serotonin transporter inhibition in a linear manner. We therefore suggest that SSRIs are tapered hyperbolically and slowly to doses much lower than therapeutic minimums, in line with tapering regimes for other medications associated with withdrawal symptoms. Withdrawal symptoms will then be minimised.

show abstract

Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care

Cited by 55 publications

References 26 publications

Long-Term and Short-Term Antidepressant Use in General Practice: Data from a Large Cohort in the Netherlands

Long-Term and Short-Term Antidepressant Use in General Practice: Data from a Large Cohort in the Netherlands

Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis

Tapering of SSRI treatment to mitigate withdrawal symptoms

Contact Info

Product

Resources

About