Van Leeuwen Ellen, Anthierens Sibyl, van Driel Mieke L, De Sutter An, De Beir Rani, Christiaens Thierry
Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium.
Unit General Practice Ghent University, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Acta Clin Belg. 2022 Dec;77(6):962-969. doi: 10.1080/17843286.2021.2024384. Epub 2022 Jan 10.
The rise in long-term antidepressant use is concerning. Long-term antidepressant (AD) use, much longer than recommended by guidelines, can result in risk of adverse events and generate unnecessary costs. In order to mitigate these risks, patients views about their antidepressants and how to discontinue need to be taken into account. We aimed to explore patients' experiences and views of discontinuing long-term AD, barriers and facilitators of discontinuation and required support.
Semi-structured face to face interviews were conducted with 14 patients with long-term AD use in primary care. Interviews were analysed thematically.
Participants describe various perceptions about discontinuation. There is fear of returning to their depression, even in those who were ambivalent about the effectiveness and safety of AD continuation. Participants describe low confidence in their own coping resources, fear of stress, and previous negative experiences with stopping. This enhances their perception of AD dependence. Participants indicate the importance of the support of their GP and their social network to help them withdraw.
Discontinuation of long-term antidepressants is a complex issue for patients. More awareness of the lack of evidence and the potential risks of long-term AD continuation is required. By raising the issue and offering support during discontinuation GPs can help their patients stop AD. A greater focus on non-pharmacological approaches of depression in primary care is needed to reduce unnecessary AD use.
长期使用抗抑郁药的情况日益增多，令人担忧。长期使用抗抑郁药（AD）的时间远远超过指南推荐时长，可能导致不良事件风险，并产生不必要的费用。为降低这些风险，需要考虑患者对其抗抑郁药的看法以及如何停药。我们旨在探讨患者停用长期抗抑郁药的经历和看法、停药的障碍与促进因素以及所需的支持。
对14名在基层医疗中长期使用抗抑郁药的患者进行了半结构化面对面访谈。采用主题分析法对访谈进行分析。
参与者描述了对停药的各种看法。即使是那些对继续使用抗抑郁药的有效性和安全性持矛盾态度的人，也担心抑郁症复发。参与者表示对自身应对能力缺乏信心，害怕压力，以及之前停药有负面经历。这增强了他们对抗抑郁药依赖的认知。参与者指出，全科医生（GP）和社交网络的支持对帮助他们停药很重要。
对患者来说，停用长期抗抑郁药是一个复杂的问题。需要更多地认识到长期使用抗抑郁药缺乏证据以及潜在风险。通过在停药期间提出这个问题并提供支持，全科医生可以帮助患者停用抗抑郁药。为减少不必要的抗抑郁药使用，需要在基层医疗中更加关注抑郁症的非药物治疗方法。
