Should I, can I, dare I? Patients’ view on stopping long-term antidepressant use, a qualitative study

Abstract

Background and aim:The rise in long-term antidepressant use is concerning. Long-term antidepressant (AD) use, much longer than recommended by guidelines, can result in risk of adverse events and generate unnecessary costs. In order to mitigate these risks, patients views about their antidepressants and how to discontinue need to be taken into account. We aimed to explore patients' experiences and views of discontinuing long-term AD, barriers and facilitators of discontinuation and required support. Methods: Semi-structured face to face interviews were conducted with 14 patients with longterm AD use in primary care. Interviews were analysed thematically. Results: Participants describe various perceptions about discontinuation. There is fear of returning to their depression, even in those who were ambivalent about the effectiveness and safety of AD continuation. Participants describe low confidence in their own coping resources, fear of stress, and previous negative experiences with stopping. This enhances their perception of AD dependence. Participants indicate the importance of the support of their GP and their social network to help them withdraw. Conclusion: Discontinuation of long-term antidepressants is a complex issue for patients. More awareness of the lack of evidence and the potential risks of long-term AD continuation is required. By raising the issue and offering support during discontinuation GPs can help their patients stop AD. A greater focus on non-pharmacological approaches of depression in primary care is needed to reduce unnecessary AD use.

The lived experience of withdrawal from Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants: A qualitative interview study

“…This was evident in a recent large online survey ( n > 1000) which revealed that less than 5% of patients reported being told anything about antidepressant withdrawal effects by their prescribers 39 . Our findings are also supported by another recent qualitative study, where participants highlighted the need for more support from healthcare professionals, a greater focus on non‐pharmacological approaches in primary care to address unnecessary antidepressant use, and increased awareness of the withdrawal process 40 . Importantly, these concerns are further reflected in national guidelines where in a 2019 report Public Health England recognised the significant challenges individuals face when withdrawing from antidepressants and called for the implementation of specialised support services and a helpline for individuals attempting to withdraw from antidepressants, 41 a need highlighted by patients as being currently lacking 42,43 .…”

Attitudes towards deprescribing in geriatric psychiatry: A survey among older psychiatric outpatients

“…advice is generally in line with previous PATD/rPATD literature, regardless of patient population and health care setting. 16 Nevertheless, the findings discussed above (i.e., the potential influence of specific concerns and past experiences on patients' deprescribing willingness) as well as the qualitative literature on patient barriers to psychotropic deprescribing 8,12,13 suggest that most older psychiatric outpatients do have significant barriers to engage in deprescribing in an actual clinical situation, in particular of their psychotropic treatment. Although some studies have adjusted the PATD/rPATD questionnaire to focus on specific drug classes (e.g., alpha-blockers, 28 proton pump inhibitors), 29 the original questionnaire is not medication-specific.…”

“…Psychotropic deprescribing can, however, be a complex process 7 . Psychotropics are often used long‐term and patients may be reluctant to stop these medications, 8 while underlying psychiatric morbidity, pharmacological dependence and withdrawal symptoms may further complicate the deprescribing process. In addition, health care professionals report multiple barriers to psychotropic deprescribing, for example, lack of qualifications and resources 9,10 …”

“…11 Qualitative literature has reported some willingness among older patients to try deprescribing long-term antidepressant use and barriers that might affect the process, including fear of symptom recurrence and relapse, lack of confidence in deprescribing capabilities and previous unsuccessful deprescribing attempts. 8,12,13 Multiple studies have also explored deprescribing attitudes of older patients in larger scale, mainly by use of the (revised) Patients' Attitudes Towards Deprescribing (PATD/ rPATD) questionnaire, 14,15 and similarly found that older patients are generally willing to try deprescribing in general. 16 Although the PATD/rPATD questionnaire has been applied in multiple health care settings, there has been limited investigation of patient attitudes in a geriatric psychiatry setting.…”

General Practice Patients’ Experiences and Perceptions of the WiserAD Structured Web-Based Support Tool for Antidepressant Deprescribing: Protocol for a Mixed Methods Case Study With Realist Evaluation

“…The majority (86%) of antidepressants are prescribed in primary care [20], placing general practitioners (GPs) in a unique position to also deprescribe (the planned and supervised process of dose reduction or cessation [21]). However, antidepressant deprescribing can be complex and does not routinely occur in clinical practice [22,23] with reported barriers by both GPs and patients, including fear of relapse or recurrence and a lack of quality guidelines for deprescribing [24][25][26][27]. Discontinuation symptoms such as tremors, sweating, anxiety, mood swings, and electric shock sensations are also associated with stopping antidepressants [28][29][30] and can be confused with relapse or recurrence.…”