Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Belgium.
Primary Care Research Centre, School of Primary Care, Population Health & Medical Education, University of Southampton, Southampton, United Kingdom.
J Affect Disord. 2024 Jul 1;356:616-627. doi: 10.1016/j.jad.2024.04.060. Epub 2024 Apr 17.
Long-term antidepressant (AD) use, much longer than recommended, is very common and can lead to potential harms.
To investigate the existing literature on perspectives of health professionals (HPs) regarding long-term AD treatment, focusing on barriers and facilitators to discontinuation.
A systematic review with thematic synthesis. Eight electronic databases were searched until August 2023 including MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, and the Networked Digital Library of Theses and Dissertation.
Thirteen studies were included in the review. Of these, nine focused on general practitioner perspectives, one on psychiatrist perspectives, and three on a mix of HPs perspectives. Barriers and facilitators to discontinuing long-term ADs emerged within eight themes, ordered chronologically based on HP considerations during an AD review: perception of AD use, fears, HP role and responsibility, HPs' perception of AD discontinuation, HPs' confidence regarding their ability to manage discontinuation, perceived patient readiness to stop, support from patient's trusted people, and support from other HPs.
Coding and development of subthemes and themes was performed by one researcher and further developed through discussion within the research team.
Deprescribing long-term ADs is a challenging concept for HPs. The review found evidence that the barriers far outweigh the facilitators with fear of relapse as a main barrier. HP education, reassurance and confidence-building is essential to increase the initiation of the discontinuation process. Further research into the perspectives of pharmacists and mental health workers is needed as well as exploring the role of trusted people.
长期使用抗抑郁药（AD），比推荐的时间长得多，是非常常见的，可能会导致潜在的危害。
调查健康专业人员（HPs）对长期 AD 治疗的看法，重点是停药的障碍和促进因素。
系统综述与主题综合。直到 2023 年 8 月，我们在 8 个电子数据库中进行了搜索，包括 MEDLINE、PubMed、Embase、PsycINFO、CINAHL、AMED、Health Management Information Consortium 和 Networked Digital Library of Theses and Dissertation。
综述共纳入 13 项研究。其中，9 项研究侧重于全科医生的观点，1 项研究侧重于精神科医生的观点，3 项研究侧重于混合 HPs 观点。在 8 个主题中出现了停止长期 AD 的障碍和促进因素，根据 HP 在 AD 审查期间的考虑，按照时间顺序排列：AD 使用的看法、恐惧、HP 角色和责任、HP 对 AD 停药的看法、HP 对其停药能力的信心、感知到患者准备停止、患者信任的人的支持、以及其他 HPs 的支持。
一个研究人员进行了编码和子主题和主题的开发，并通过研究团队内部的讨论进一步开发。
为 HPs 停止长期使用 AD 是一个具有挑战性的概念。该综述发现，证据表明障碍远远超过促进因素，复发的恐惧是一个主要障碍。对 HP 进行教育、提供保证和建立信心对于启动停药过程至关重要。还需要进一步研究药剂师和心理健康工作者的观点，并探索值得信赖的人的作用。
