Box 2.

Themes and subthemes

Theme 1: Discontinuation of long-term use of antidepressants is not a simple deprescribing decision
SubthemeFocus
Assessing patient preparednessPatients’ 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-makingGPs described decision-making about discontinuation in intuitive and relational terms.
Weighing up benefits and risksGPs 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
SubthemeFocus
Planting the seed for changeGPs valued a process of careful preparation for discontinuation.
Co-designing a personalised planA 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 discontinuationGPs emphasised regular review and encouragement of social and lifestyle supports during and beyond discontinuation.
Theme 3: Supporting change in GPs’ prescribing practices
SubthemeFocus
Redressing repeat prescribing as the quick fixGPs expressed distrust in prescribing norms and felt a need to shift away from ‘set and forget’ attitudes.
Inadequate evidence to support discontinuationDiscussions with patients about discontinuation would be facilitated by better evidence about the harms of long-term use.
Practice-based changeGPs expressed well-communicated ideas about practice level change that would help them discontinue antidepressants.
Solutions beyond general practiceDiscontinuation 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).