Kelly Dervla, Graffi Justin, Noonan Maria, Green Philip, McFarland John, Hayes Peter, Glynn Liam
School of Medicine and Health Research Institute Health Implementation Science Research Cluster, University of Limerick, Limerick, Ireland
School of Medicine, University of Limerick, Limerick, Ireland.
BMJ Open. 2021 Apr 5;11(4):e046054. doi: 10.1136/bmjopen-2020-046054.
Our aim was to explore general practitioners' (GPs) perceptions and experiences of discontinuing antidepressants.
A qualitative study using semistructured interviews was undertaken between July 2019 and March 2020. The interviews were transcribed and analysed using a thematic analysis framework.
GPs affiliated with a university education and research network for general practice in Ireland.
A purposive sample of GPs (n=10).
Five themes emerged: shared decision-making; personalised therapy; medication-tapering toolkit; health service factors and concerns around tapering. GPs described being less likely to engage in deprescribing for patients with long-term and/or recurrent depression, older patients and those with comorbidities due to fear of relapse. Access to evidence-based psychological therapies, guidelines, information on rates of relapse, patient leaflets on discontinuing antidepressants and reminder prompts on GP-prescribing software were suggested to optimise appropriate antidepressant discontinuation. There was some suggestion that patients may use antidepressants for longer when talk therapy is not available or taken up.
GPs are largely confident in their role of managing mild-to-moderate depression and deprescribing antidepressants. This study provides an insight into factors that influence GPs' decisions to deprescribe antidepressants. More information on rates of relapse after discontinuation would be helpful to inform decision-making.
我们的目的是探讨全科医生（GP）对停用抗抑郁药的看法和经验。
2019年7月至2020年3月期间进行了一项采用半结构化访谈的定性研究。访谈内容进行了转录，并使用主题分析框架进行分析。
隶属于爱尔兰大学全科医学教育与研究网络的全科医生。
采用立意抽样法选取的全科医生样本（n = 10）。
出现了五个主题：共同决策；个性化治疗；减药工具包；卫生服务因素以及对减药的担忧。全科医生表示，由于担心复发，他们不太可能对患有长期和/或复发性抑郁症的患者、老年患者以及患有合并症的患者进行撤药。建议提供循证心理治疗、指南、复发率信息、关于停用抗抑郁药的患者传单以及全科医生开方软件上的提醒提示，以优化抗抑郁药的合理停用。有迹象表明，当无法获得或未采用谈话治疗时，患者可能会更长时间使用抗抑郁药。
全科医生对其管理轻度至中度抑郁症和停用抗抑郁药的作用基本有信心。本研究深入了解了影响全科医生停用抗抑郁药决策的因素。更多关于停药后复发率的信息将有助于为决策提供依据。
