Department of General Practice, The University of Melbourne, Melbourne, VIC, 3004, Australia.
Research Department of Primary Care and Population Health, University College, London, NW3 2PF, UK.
Prim Health Care Res Dev. 2023 Feb 27;24:e16. doi: 10.1017/S1463423623000038.
Current treatment guidelines advise that the deprescribing of antidepressants should occur around 6 months post-remission of symptoms. However, this is not routinely occurring in clinical practice, with between 30% and 50% of antidepressant users potentially continuing treatment with no clinical benefit. To support patients to deprescribe antidepressant treatment when clinically appropriate, it is important to understand what is important to patients when making the decision to reduce or cease antidepressants in a naturalistic setting.
The current study aimed to describe the self-reported reasons primary care patients have for reducing or stopping their antidepressant medication.
Three hundred and seven participants in the longitudinal study reported taking an SSRI/SNRI over the life of the study. Of the 307, 179 reported stopping or tapering their antidepressant during computer-assisted telephone interviews and provided a reason for doing so. A collective case study approach was used to collate the reasons for stopping or tapering.
Reflexive thematic analysis of patient-reported factors revealed five overarching themes; 1. Depression; 2. Medication; 3. Healthcare system; 4. Psychosocial, and; 5. Financial. These findings are used to inform suggestions for the development and implementation of antidepressant deprescribing discussions in clinical practice.
目前的治疗指南建议，在症状缓解后 6 个月左右应停止使用抗抑郁药。然而，这在临床实践中并没有常规发生，有 30%至 50%的抗抑郁药使用者可能继续接受治疗，但没有临床获益。为了支持患者在临床适当的情况下停止使用抗抑郁药物，了解患者在自然环境中决定减少或停止使用抗抑郁药物时的重要因素是很重要的。
本研究旨在描述初级保健患者在减少或停止抗抑郁药物治疗时自我报告的原因。
在这项纵向研究中，有 307 名参与者报告在研究期间服用了 SSRI/SNRI。在这 307 名参与者中，有 179 名在计算机辅助电话访谈中报告停止或逐渐减少他们的抗抑郁药物，并提供了停止或减少的原因。采用集体案例研究方法来整理停止或减少的原因。
对患者报告的因素进行反思性主题分析揭示了五个总体主题：1. 抑郁；2. 药物；3. 医疗保健系统；4. 心理社会；5. 财务。这些发现用于为临床实践中抗抑郁药物减少讨论的制定和实施提供建议。
