What helps, what hinders antidepressant discontinuation? Qualitative analysis of patients’ experiences and expectations
Publication date
2024-06-27
Document type
Forschungsartikel
Author
Organisational unit
ISSN
Series or journal
British Journal of General Practice
Periodical volume
74
Periodical issue
744
First page
e466
Last page
e474
Peer-reviewed
✅
Part of the university bibliography
✅
Keyword
Major depressive disorder
Primary health care
Psychotropic drugs
Germany
Abstract
Background: Many patients with depressive disorders use antidepressants longer than clinically indicated. Long-term use is associated with high individual and societal costs. Patients often perceive antidepressant discontinuation as challenging. Aim: To understand patients’ expectations towards discontinuation, document their experiences with long-term use and discontinuation, and identify factors that can help or hinder discontinuation. Design and Setting: Qualitative study using semi-structured interviews via telephone with adult patients in Germany. Method: Thirty-two patients with remitted Major Depressive Disorder and long-term antidepressant use were interviewed. We analysed transcripts with content analysis aided by MaxQDA to derive thematic categories. Results: Patients expected to eliminate side effects or regain independence following discontinuation. Such positive expectations were perceived as facilitators and motivated patients’ discontinuation wish. However, patients also had negative expectations such as recurrence or discontinuation symptoms. Patients’ negative expectations were often fuelled by negative experiences, persisted despite a wish to stop antidepressants, and hindered discontinuation. Most patients perceived antidepressants as effective, but experienced side effects and further hassles. Patients felt inadequately informed about treatment duration and methods for discontinuation. Further barriers and facilitators included a stable environment, availability of support, and treatment information. Conclusion: Patients prefer to discontinue antidepressants within structured frameworks that provide information and support. Identified facilitators and barriers may help optimise appropriate use and discontinuation of antidepressants in routine practice. The utility of functional expectations and specification of individualised approaches to minimise dysfunctional expectations, adapted to patients’ previous experiences, appear to be especially important.
Version
Published version
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Open access