REDUCE antidepressant reduction feasibility RCT

Problem

There is concern about increasing antidepressant use, now in around 1-in-10 adults. Some people need long-term antidepressants to stop them getting depressed, but a third-to-a-half could possibly stop them without relapsing. When GPs review patients on long-term antidepressants and recommend that they could begin to stop taking them, only 1-in-14 is able to stop. The REDUCE (REviewing long term antiDepressant Use by Careful monitoring in Everyday practice) study aims to identify safe, effective, and cost-effective ways of helping patients taking long-term antidepressants taper off and stop treatment, when appropriate. REDUCE work stream 4 aimed to determine the feasibility of a randomised controlled trial of online interventions to support practitioners and guide patients on coming off antidepressants, assess the acceptability of the Internet interventions, recruitment of practitioners and patients, and acceptability of planned outcome measures.

Approach

Inclusion criteria: Patients taking antidepressants for longer than a year for a first episode of depression, or longer than two years for repeated episodes of depression, who are feeling well and would like to consider tapering off their antidepressants.Intervention: practitioner and patient access to ADvisor internet programmes designed to support antidepressant withdrawal, plus three patient telephone calls from a psychological wellbeing practitioner (PWP). Control arm received usual care.Assessments: baseline, 3 months, and 6 months. Primary outcome PHQ-9 at 6 months for depressive symptoms, secondary outcomes discontinuation of antidepressants, social functioning, wellbeing, enablement, quality of life, satisfaction, and use of health services for costs. Qualitative interviews to gather experiences of taking part.

Findings

Recruitment of target of 14 practices was quickly achieved. Recruitment of sufficient patients was also achieved (211 responses from 791 letters given or sent to patients (26.6%); of 80 patients screened, 53 (66%) were eligible, so we recruited 13 more than the target of 40. Evidence that the interventions were acceptable and engaging, from the 10 GP & nurse, and 18 patient interviews, and audio-recordings of the PWP support calls. Follow-up rate at 3 months 78.8%; at 6 months 81.6%. Questionnaire measures rated acceptable, and feasible in the time available.

Consequences

We met the funder's criteria for moving to the main trial, and we are well prepared to start WS5. The trial met the ACCEPT criteria for inclusion of the patients in with the main trial as an internal pilot. The research remains valuable, and if the findings are positive they can be readily disseminated.