Van Leeuwen Ellen, Mehuys Els, Johnson Chris F, De Keyzer An-Sofie, Boussery Koen, Christiaens Thierry
Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences & Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium.
Ther Adv Psychopharmacol. 2025 Apr 27;15:20451253251333977. doi: 10.1177/20451253251333977. eCollection 2025.
Long-term use of antidepressant drugs is widespread despite guidelines recommending limited duration. General practitioners (GPs) play a central role in reviewing and discontinuing antidepressants, although they hesitate to initiate a discussion about the long-term use. The potential role of pharmacists in this process is underexplored, despite their pharmaceutical expertise and accessibility.
To explore community pharmacists' perspectives on the discontinuation of long-term use of antidepressants, and the barriers and facilitators to their involvement in this process.
Qualitative study.
Semi-structured interviews were conducted with 14 Belgian community pharmacists until data saturation. Interviews were recorded, transcribed, and thematically analyzed.
Four themes emerged. (1) "Antidepressants at the pharmacy: a persistent taboo" showed pharmacists' hesitancy to initiate discontinuation discussions due to societal stigma and fear of being perceived as nosy. (2) "Balancing risks vs benefits" highlights that pharmacists were primarily concerned about relapse in stable patients but recognized that a patient request from a patient experiencing side effects may facilitate discontinuation. (3) "Is this my role?," pharmacists viewed GPs as the primary decision-makers in discontinuation, limiting their role to supporting GP treatment decisions. Key facilitators for discontinuation included a GP's decision to stop and a motivated patient. Regular reviews by the pharmacist could also facilitate the discontinuation process. (4) Optimizing pharmacists' role' with a strong need for GP collaboration, and acknowledging a need to optimize knowledge and skills to support antidepressant discontinuation.
Our study reveals that pharmacists viewed GPs as pivotal in the discontinuation process, as they make the decisions, while they see their role as supportive, following the doctor's decision. However, they faced significant barriers to discontinuing long-term antidepressants, including fear of relapse, societal taboo, and unclear responsibilities. More education, confidence building, and better collaboration with GPs could empower pharmacists to play a proactive role, improving the antidepressant discontinuation process.
尽管指南建议限制使用时长，但抗抑郁药物的长期使用仍很普遍。全科医生（GP）在审查和停用抗抑郁药物方面发挥着核心作用，尽管他们不愿就长期使用展开讨论。尽管药剂师具备药学专业知识且容易接触到患者，但他们在这一过程中的潜在作用尚未得到充分探索。
探讨社区药剂师对停用长期使用的抗抑郁药物的看法，以及他们参与这一过程的障碍和促进因素。
定性研究。
对14名比利时社区药剂师进行半结构化访谈，直至数据饱和。访谈进行录音、转录并进行主题分析。
出现了四个主题。（1）“药房里的抗抑郁药物：一个持续存在的禁忌”表明，由于社会污名以及担心被视为爱管闲事，药剂师不愿发起停药讨论。（2）“权衡风险与益处”强调，药剂师主要担心病情稳定的患者复发，但认识到出现副作用的患者提出停药请求可能有助于停药。（3）“这是我的职责吗？”药剂师将全科医生视为停药的主要决策者，将自己的角色限制为支持全科医生的治疗决策。停药的关键促进因素包括全科医生的停药决定和积极主动的患者。药剂师的定期复查也可以促进停药过程。（4）“优化药剂师的角色”迫切需要与全科医生合作，并认识到需要优化知识和技能以支持抗抑郁药物的停用。
我们的研究表明，药剂师认为全科医生在停药过程中起关键作用，因为是他们做出决定，而药剂师认为自己的角色是在医生做出决定后提供支持。然而，他们在停用长期抗抑郁药物方面面临重大障碍，包括对复发的担忧、社会禁忌以及职责不明确。更多的教育、增强信心以及与全科医生更好的合作可以使药剂师发挥积极作用，改善抗抑郁药物的停药过程。
