Role of primary care in depression relapse: a qualitative study

Andrew S Moriarty; Emma Williams; Dean McMillan; Simon Gilbody; Carolyn A Chew-Graham

doi:10.3399/BJGP.2024.0384

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Role of primary care in depression relapse
Marion Brown

Published on: 20 March 2025

Published on: (20 March 2025)
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Role of primary care in depression relapse
Marion Brown, Retired, none
This study is indicative of ‘what is happening’ on a wide scale – being that “GPs reported that they would be more inclined to continue antidepressant medication in patients with a history of relapse.”¹
“Other research has shown that fear of relapse is a barrier to patients discontinuing antidepressant medication, some patients confuse relapse with discontinuation symptoms, and that patients may not have full confidence in their GP’s ability to discuss antidepressant discontinuation owing to a perceived lack of knowledge and time.”¹

Unfortunately, doctors themselves have, for decades now, been confusing relapse with ‘discontinuation’ symptoms. We wrote about this is our 2020 ‘Patient Voice’ paper “The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition.”²

Stevie Lewis’s 2022 article for BJGP includes this paper and others: Four research papers I wish my GP had read before prescribing antidepressants. “I would suggest the following four, chosen because each of them addresses some element of my 17 years spent on these drugs, helping to make sense of what happened to me, and to explain why it was such a painfully long and unpleasant journey.”³

The Maudsley Deprescribing Guidelines, rev...
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This study is indicative of ‘what is happening’ on a wide scale – being that “GPs reported that they would be more inclined to continue antidepressant medication in patients with a history of relapse.”¹
“Other research has shown that fear of relapse is a barrier to patients discontinuing antidepressant medication, some patients confuse relapse with discontinuation symptoms, and that patients may not have full confidence in their GP’s ability to discuss antidepressant discontinuation owing to a perceived lack of knowledge and time.”¹

Unfortunately, doctors themselves have, for decades now, been confusing relapse with ‘discontinuation’ symptoms. We wrote about this is our 2020 ‘Patient Voice’ paper “The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition.”²

Stevie Lewis’s 2022 article for BJGP includes this paper and others: Four research papers I wish my GP had read before prescribing antidepressants. “I would suggest the following four, chosen because each of them addresses some element of my 17 years spent on these drugs, helping to make sense of what happened to me, and to explain why it was such a painfully long and unpleasant journey.”³

The Maudsley Deprescribing Guidelines, reviewed for BJGP by Sian Gordon,⁴ was written in order to assist doctors to better understand and manage safer withdrawal from antidepressants (and other dependence-forming prescribed drugs) “I also cannot help but reflect on the medical profession’s reluctance to accept what their patients were telling them about drug effects”. Per letter response: “The new Maudsley guidebook contains a wealth of background information and evidence, then step-by-step detailed ‘tapering’ options for each individual drug. It will do much to assist prescribers, patients, and the public to learn the all-important difference between ‘relapse’ and ‘withdrawal’, and to more safely navigate what seems to have been a serious void in understanding of the optimal use of these medicines.”⁵

A video has been made in Australia describing patient experiences. Doctor-Patient relationships have suffered as a consequence of doctors apparently not understanding the bewildering effects of these drugs, especially when ‘discontinued’ https://youtu.be/HnG6om8ufrQ?si=8H9HPJKmTzoBgb47

References

Moriarty AS, Williams E, McMillan D, Gilbody S, Chew-Graham CA. Role of primary care in depression relapse: a qualitative study. Br J Gen Pract 2025 Feb 24:BJGP.2024.0384. doi: 10.3399/BJGP.2024.0384.

Guy A, Brown M, Lewis S, Horowitz M. The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition. Ther Adv Psychopharmacol 2020; 10:2045125320967183. doi:10.1177/2045125320967183.

Lewis S. Four research papers I wish my GP had read before prescribing antidepressants. Br J Gen Pract 2021 Jun 24;71(708):316-317. doi: 10.3399/bjgp21X716321.

Gordon S. Books: The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs. Br J Gen Pract 2024; 74 (745): 369-370. DOI: 10.3399/bjgp24X739029

Brown M. Book review: The Maudsley Deprescribing Guidelines. Marion Brown. Br J Gen Pract 2024; 74 (746): 397-398. DOI: 10.3399/bjgp24X739209

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Competing Interests: None declared.

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