Abstract
BackgroundThere 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.AimTo explore GPs’ insights about long-term antidepressant prescribing and discontinuation.Design and settingA qualitative interview study with Australian GPs.MethodSemi-structured interviews explored GPs’ discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis.ResultsThree 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.ConclusionGPs 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.
Highlights
IntroductionGeneral practice is the setting in which depression is most commonly treated and antidepressants initiated and maintained.[2,21,22] And whilst most long-term use is associated with recurrent depression, one third of long-term users are in remission with no clear reason for continued use.[21,23] This suggests considerable scope within general practice for treatment re-evaluation and discontinuation of antidepressants
Three overarching themes were identified from interviews with 22 general practitioners’ (GP)
Participants were aged between 33-73 years, with 13 male and 9 female, 16 practiced in the state of Queensland, and the number of years since graduation ranged from 5-34 years
Summary
General practice is the setting in which depression is most commonly treated and antidepressants initiated and maintained.[2,21,22] And whilst most long-term use is associated with recurrent depression, one third of long-term users are in remission with no clear reason for continued use.[21,23] This suggests considerable scope within general practice for treatment re-evaluation and discontinuation of antidepressants. 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 rather than new prescriptions. 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.
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