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). |