PT  - JOURNAL ARTICLE
AU  - Maria Donald
AU  - Riitta Partanen
AU  - Leah Sharman
AU  - Johanna Lynch
AU  - Genevieve A Dingle
AU  - Catherine Haslam
AU  - Mieke van Driel
TI  - Long-term antidepressant use in general practice: a qualitative study of GPs’ views on discontinuation
AID  - 10.3399/BJGP.2020.0913
DP  - 2021 Jul 01
TA  - British Journal of General Practice
PG  - e508--e516
VI  - 71
IP  - 708
4099  - http://bjgp.org/content/71/708/e508.short
4100  - http://bjgp.org/content/71/708/e508.full
SO  - Br J Gen Pract2021 Jul 01; 71
AB  - Background There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term use, rather than new prescriptions. Most antidepressant prescriptions are generated in general practice, and it is likely that attempts to discontinue are either not occurring or are proving unsuccessful.Aim To explore GPs’ insights about long-term antidepressant prescribing and discontinuation.Design and setting A qualitative interview study with Australian GPs.Method Semi-structured interviews explored GPs’ discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis.Results Three overarching themes were identified from interviews with 22 GPs. The first, ‘not a simple deprescribing decision’, spoke to the complex decision-making GPs undertake in determining whether a patient is ready to discontinue. The second, ‘a journey taken together’, captured a set of steps GPs take together with their patients to initiate and set-up adequate support before, during, and after discontinuation. The third, ‘supporting change in GPs’ prescribing practices’, described what GPs would like to see change to better support them and their patients to discontinue antidepressants.Conclusion GPs see discontinuation of long-term antidepressant use as more than a simple deprescribing decision. It begins with considering a patient’s social and relational context, and is a journey involving careful preparation, tailored care, and regular review. These insights suggest interventions to redress long-term use will need to take these considerations into account and be placed in a wider discussion about the use of antidepressants.