Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium.
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Scand J Prim Health Care. 2021 Dec;39(4):533-542. doi: 10.1080/02813432.2021.2006487. Epub 2021 Dec 11.
Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs. Most antidepressants are prescribed by general practitioners (GPs) but it remains unclear why they do not discontinue long-term use.
To explore GPs' views and experiences of discontinuing long-term antidepressants, barriers and facilitators of discontinuation and required support.
Qualitative study in Belgian GPs.
20 semi-structured face-to-face interviews with GPs. Interviews were analysed thematically.
The first theme, 'Success stories' describes three strong motivators to discontinue antidepressants: patient health issues, patient requests and a new positive life event. Second, not all GPs consider long-term antidepressant use a 'problem' as they perceive antidepressants as effective and safe. GPs' main concern is the risk of relapse. Third, GPs foresee that discontinuation of antidepressants is not an easy and straightforward process. GPs weigh up whether they have the necessary skills and whether it is worth the effort to start this process.
Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs, especially in the absence of a facilitating life-event or patient demand. The absence of a compelling need for discontinuation and fear of relapse of symptoms in a stable patient are important barriers for GPs when considering discontinuation. In order to increase GPs' motivation to discontinue long-term antidepressants, more emphasis on the futility of the actual effect and on potential harms related to long-term use is needed.KEY POINTSCurrent awareness:Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs.Main statements: • Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs. • More emphasis on the futility of the actual effect of antidepressants and on potential harms related to long-term use is needed.
长期使用抗抑郁药，远远超过指南推荐的时间，会对患者造成伤害并产生不必要的费用。大多数抗抑郁药都是由全科医生（GP）开具的，但目前尚不清楚他们为何不停止长期使用。
探讨全科医生停止长期使用抗抑郁药的看法和经验、停药的障碍和促进因素以及所需的支持。
比利时全科医生的定性研究。
对 20 名全科医生进行了 20 次半结构化的面对面访谈。对访谈进行了主题分析。
第一个主题“成功案例”描述了停止使用抗抑郁药的三个主要动机：患者健康问题、患者要求和新的积极生活事件。其次，并非所有的全科医生都认为长期使用抗抑郁药是一个“问题”，因为他们认为抗抑郁药是有效和安全的。全科医生最关心的是复发的风险。第三，全科医生预计停药不是一个简单直接的过程。他们权衡自己是否具备必要的技能，以及是否值得努力开始这个过程。
对于全科医生来说，停止长期使用抗抑郁药是一个困难和不确定的过程，尤其是在没有促进性的生活事件或患者需求的情况下。缺乏停药的强烈需求以及对稳定患者症状复发的担忧，是全科医生在考虑停药时的重要障碍。为了提高全科医生停止长期使用抗抑郁药的动机，需要更加重视抗抑郁药实际效果的无效性以及与长期使用相关的潜在危害。
当前认知：长期使用抗抑郁药，远远超过指南推荐的时间，会对患者造成伤害并产生不必要的费用。
主要观点：
停止长期使用抗抑郁药对全科医生来说是一个困难且不确定的过程。
需要更加重视抗抑郁药实际效果的无效性以及与长期使用相关的潜在危害。
