Article Figures & Data
Tables
How this fits in
Most antidepressant prescriptions are initiated and continued in general practice and discontinuation can be challenging. Understanding GPs’ insights into decision-making around discontinuing long-term antidepressant use is needed to underpin change. This study pointed to discontinuation as a journey for the GP–patient dyad that is not a simple deprescribing decision but is built on relationship and grounded in enabling social context. Experiences and opinions Can you think of a patient for whom discontinuing long-term antidepressant use was successful and describe the experience and the process used? (long-term >2 years)
Now can you think of a patient for whom discontinuing long-term antidepressant use was unsuccessful and describe how the experience was different and why you think the attempt was unsuccessful?
We know distinguishing between relapse and withdrawal symptoms can be challenging, can you talk a little about your experience with this in relation to discontinuing long-term antidepressant use?
Can you describe your monitoring and reviewing process for patients on antidepressant therapy?
In general terms, what do you think about the role of antidepressants in treating depression?
Decision-making What factors play a role in your decision to continue or discontinue long-term antidepressant use?
What do you see as the risks of stopping long-term antidepressant treatment?
What do you see as the benefits of stopping long-term antidepressant treatment?
Support for GPs To what extent do you feel you have sufficient knowledge and experience to advise patients correctly and to help them with discontinuing antidepressants?
What would you need to discontinue long-term antidepressant use with more patients?
Non-pharmacological support for patients What non-pharmacological interventions do you refer patients to?
Are you aware of any low-intensity non-pharmacological interventions (such as online CBT, guided self-help, wellbeing apps or websites) for patients and do you ever suggest them to your patients?
The idea of social prescribing in general practice (or community referral to social groups) is gaining momentum as a model of care, do you have any thoughts about it and its use in supporting patients who are discontinuing long-term antidepressant use?
Theme 1: Discontinuation of long-term use of antidepressants is not a simple deprescribing decision Subtheme Focus Assessing patient preparedness Patients’ life circumstances are as important as recovery from depression in assessing patient preparedness for discontinuation. GPs acknowledged patient relationships with antidepressants that can disrupt preparedness to discontinue. Subjective and relational decision-making GPs described decision-making about discontinuation in intuitive and relational terms. Weighing up benefits and risks GPs recognised patient empowerment and sense of recovery as potent motivators for ceasing long-term use. Theme 2: Discontinuation of long-term use of antidepressants is a journey taken together by patient and GP Subtheme Focus Planting the seed for change GPs valued a process of careful preparation for discontinuation. Co-designing a personalised plan A tailored plan of action enables GPs and patients to increase the likelihood of successful discontinuation: a gradual dose reduction plan and proactive relapse plan are considered crucial. Care continues during and after discontinuation GPs emphasised regular review and encouragement of social and lifestyle supports during and beyond discontinuation. Theme 3: Supporting change in GPs’ prescribing practices Subtheme Focus Redressing repeat prescribing as the quick fix GPs expressed distrust in prescribing norms and felt a need to shift away from ‘set and forget’ attitudes. Inadequate evidence to support discontinuation Discussions with patients about discontinuation would be facilitated by better evidence about the harms of long-term use. Practice-based change GPs expressed well-communicated ideas about practice level change that would help them discontinue antidepressants. Solutions beyond general practice Discontinuation of long-term antidepressant use at the level of the GP–patient alliance will be leveraged by action at the broader system level (for example, social and policy).
Supplementary Data
PODCAST
In this issue
Jump to section
Keywords
More in this TOC Section
Related Articles
Cited By...
