University of Southampton Primary Care & Population Sciences, Aldermoor Health Centre, Southampton SO16 5ST, UK.
Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
J Affect Disord. 2019 Feb 15;245:38-62. doi: 10.1016/j.jad.2018.10.107. Epub 2018 Oct 17.
To explore patient and health professional views and experiences of antidepressant treatment with particular focus on barriers and facilitators to discontinuing use.
Systematic review with thematic synthesis DATA SOURCES: MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, OpenGrey, and the Networked Digital Library of Theses and Dissertations from inception until February 2017. Updated searches were carried out in July 2018.
Primary studies, published in English, that used qualitative data collection and analysis, and had data on attitudes, beliefs, feelings, perceptions on continuing or discontinuing antidepressant use, of patients (aged 18 or above, who received treatment with antidepressants for at least 6 months) or any health professionals.
One reviewer extracted data and assessed study quality, which was checked by a second reviewer.
Twenty two papers were included in the review. A thematic synthesis was performed for patient perspectives only, due to insufficient data from a health professional perspective. The thematic synthesis yielded nine themes: (1) psychological and physical capabilities; (2) perception of antidepressants; (3) fears; (4) intrinsic motivators and goals; (5) the Doctor as a navigator to maintenance or discontinuation; (6) perceived cause of depression; (7) aspects of information that support decision-making; (8) significant others - a help or a hindrance; and (9) support from other health professionals.
Coding and development of subthemes and themes was performed by one researcher and further developed through discussion between two researchers.
Barriers and facilitators to discontinuing antidepressant use are numerous and complex, and likely to require detailed conversations between patients and their general practitioners (GPs). These conversations are more likely to happen if GPs raise the issue of discontinuation. Further research from a health professional perspective including, but not limited to GPs, is needed.
探讨患者和卫生专业人员对抗抑郁治疗的看法和经验，特别关注停止使用的障碍和促进因素。
系统综述与主题综合
MEDLINE、PubMed、Embase、PsycINFO、CINAHL、AMED、健康管理信息联盟、OpenGrey 和网络数字论文和学位论文图书馆，从成立到 2017 年 2 月。2018 年 7 月进行了更新搜索。
主要研究，以英文发表，使用定性数据收集和分析，并具有关于继续或停止使用抗抑郁药的态度、信念、感受、看法的数据，患者（年龄在 18 岁或以上，接受抗抑郁药治疗至少 6 个月）或任何卫生专业人员。
一名审查员提取数据并评估研究质量，由第二名审查员进行检查。
综述共纳入 22 篇论文。由于卫生专业人员观点的数据不足，仅对患者观点进行了主题综合。主题综合产生了九个主题：（1）心理和身体能力；（2）对抗抑郁药的看法；（3）恐惧；（4）内在动机和目标；（5）医生作为维持或停止治疗的导航员；（6）抑郁的感知原因；（7）支持决策的信息方面；（8）重要他人 - 帮助或阻碍；（9）来自其他卫生专业人员的支持。
编码和子主题和主题的发展由一名研究人员进行，并通过两名研究人员之间的讨论进一步发展。
停止使用抗抑郁药的障碍和促进因素很多且复杂，可能需要患者和他们的全科医生（GP）之间进行详细的对话。如果 GP 提出停药问题，这种对话更有可能发生。需要从卫生专业人员的角度进行进一步的研究，包括但不限于全科医生。
