Verbeek-Heida Pietje M, Mathot Edith F
Department of Sociology and Anthropology, University of Amsterdam, Oudezijds Achterburgwal 185, 1012, DK Amsterdam.
Chronic Illn. 2006 Jun;2(2):133-42. doi: 10.1177/17423953060020020801.
Patients need to be informed not only about the effects and side-effects of their prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs), but also about the consequences of stopping treatment with this medication. However, the professional guidelines on how to inform patients about stopping are not well developed and no consensus has yet been reached. This study focuses on the dilemmas involved in continuing or stopping the use of SSRIs from the perspective of the users and explores why these dilemmas tend to be solved by continuing rather than stopping.
A qualitative study of the views of 16 SSRI users in The Netherlands was performed. Most interviews were conducted at the subject's own home, and all were tape-recorded with permission, and transcribed verbatim. The analysis is based on grounded theory, aiming at the systematic development of theories and hypotheses through the inspection of interview responses. Emerging themes were discussed and refined using the constant comparative method.
The SSRI users in this study had reached a certain balance after a period of trial and error. Feeling good could mean doing without these medicines, but could equally be because of the continuing use of these medicines. The SSRI users explained that it would be normal to stop at some time in the future. Some tried to stop but did not succeed, because they experienced serious drawbacks, so they continued, although they feared addiction and hoped that they would be able to stop at a later date. Others had never tried to stop, but said that they would like to because it is not normal to stay on this treatment forever. However, they were afraid that they would lose the balance that they had achieved in living a normal life. To support their choice of continuing SSRI use, they presented reasons why, in their case, this continuation was necessary. They all feared or had experiences with drawbacks, and were concerned and uncertain because of contradictory professional and lay messages about stopping the use of antidepressants, especially SSRIs. The fear and uncertainty about stopping without sufficient guidance were stronger than the fear and uncertainty about continuing. Users tended to stay on the safe side: better safe than sorry.
The fact that users mentioned their arguments for continuing so explicitly implies that they regarded their SSRI use as problematic and ambivalent. They feared that there would be problems in stopping, and mentioned disagreements on this subject among professionals and in the media. Users saw doctors as important in tackling their fears. Doctors could play an active role in the process of discontinuation, but they have to be aware that as soon as users lose their balance and are unable to live a normal life they will probably decide to continue. Greater agreement on guidelines is needed to support doctors in this matter, when both the patient and the doctor have decided to stop treatment.
患者不仅需要了解所开抗抑郁药（如选择性5-羟色胺再摄取抑制剂，SSRIs）的疗效和副作用，还需要了解停用此类药物的后果。然而，关于如何告知患者停药的专业指南并不完善，尚未达成共识。本研究从使用者的角度关注继续或停用SSRIs所涉及的困境，并探讨为何这些困境往往通过继续用药而非停药来解决。
对荷兰16名SSRIs使用者的观点进行了定性研究。大多数访谈在受试者家中进行，所有访谈均在获得许可后进行录音，并逐字转录。分析基于扎根理论，旨在通过检查访谈回复系统地发展理论和假设。使用持续比较法对新出现的主题进行讨论和完善。
本研究中的SSRIs使用者在经历一段时间的试验和错误后达到了某种平衡。感觉良好可能意味着不用这些药物，但也可能是因为持续使用这些药物。SSRIs使用者解释说，在未来某个时候停药是正常的。一些人试图停药但未成功，因为他们经历了严重的不良反应，所以他们继续用药，尽管他们担心上瘾，并希望以后能够停药。其他人从未尝试过停药，但表示愿意停药，因为永远依赖这种治疗是不正常的。然而，他们担心会失去在正常生活中所达到的平衡。为了支持他们继续使用SSRIs的选择，他们阐述了在自己的情况下这种持续用药必要的原因。他们都害怕或有过不良反应的经历，并且由于关于停用抗抑郁药（尤其是SSRIs）的专业信息和非专业信息相互矛盾而感到担忧和不确定。在没有充分指导的情况下停药的恐惧和不确定性比继续用药的恐惧和不确定性更强。使用者倾向于选择安全的做法：宁求稳妥，不招后悔。
使用者如此明确地提及他们继续用药的理由，这一事实意味着他们认为自己使用SSRIs存在问题且矛盾。他们担心停药会出现问题，并提到专业人士和媒体在这个问题上存在分歧。使用者认为医生在消除他们的恐惧方面很重要。医生在停药过程中可以发挥积极作用，但他们必须意识到，一旦使用者失去平衡且无法正常生活，他们可能就会决定继续用药。在患者和医生都决定停药时，需要在指南上达成更大的共识，以支持医生处理此事。
