Identifying essential components of an antidepressant deprescribing intervention

Problem

Antidepressants (AD) are an established treatment option for the acute management of depressive and anxiety disorders, two of the most prevalent mental health conditions in our community. Rates of antidepressant (AD) prescribing have doubled in the last decade, primarily as a result of an increasing duration of use. The majority of ADs are prescribed in primary care. Despite guidelines recommending ADs be ceased after a period of symptom stability, studies show that up to half of long-term users fail to meet criteria which would support long-term use. Placebo controlled trials show that ADs can be safely ceased when no longer needed but there is little evidence to support how best to do this.

Approach

This project aimed to identify the barriers to reducing inappropriate use of ADs in general practice, to enable the development of an engaging and evidence-informed intervention to assist GPs and patients navigate the process of AD cessation. We conducted separate focus groups with GPs and individuals with a history of long-term AD use (current or past). Broad topic guides were used to facilitate discussion on long term antidepressant use, perceived issues with ceasing antidepressants, and the desired components of an intervention to assist in the cessation process. Focus groups were recorded, transcribed, and reviewed by the research team both independently and as a group to identify key themes.

Findings

While there were some similarities between patients and GPs, important differences in their views about AD cessation also emerged. Patients desired more information about ADs and their cessation than GPs thought was needed, and a more structured cessation program. Patients also desired more support than would be feasible for most GPs to provide in usual practice. From the focus groups it emerged that a deprescribing intervention should include information, alternative management strategies, clear tapering schedule, and proactive support and monitoring.

Consequences

Patients and GPs need assistance to manage the AD cessation process. We have developed and are testing an intervention that provides a structured approach to de-prescribing ADs in inappropriate users in general practice.