Health professionals views on discontinuation of long-term antidepressants: a systematic review and thematic synthesis

Conference: 
SAPC ASM 2023 - Brighton
Talk Code: 
3B.1
Presenter: 
Ellen Van Leeuwen
Co-authors: 
Emma Maund, Catherine Woods, Tony Kendrick, Sibyl Anthierens, Thierry Christiaens
Author institutions: 
Clinical Pharmacology Unit & Public Health and Primary Care, Ghent University, Belgium; Primary Care & Population Sciences, University of Southampton, UK; Family Medicine and Population Health, University of Antwerp, Belgium;

Problem

Long-term antidepressant use, much longer than recommended by guidelines, may cause harmful effects and generate unnecessary costs. This study aims to investigate health professionals (HP) views on long-term antidepressant discontinuation and their barriers and facilitators.

Approach

Systematic review and meta-synthesis. We included primary studies that used qualitative data collection and had data on any HP's attitudes, beliefs, feelings, and perceptions on continuing or discontinuing AD use. The review searched nine database sources from inception until May 2022. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklist. A thematic synthesis was performed.

Findings

Thirteen studies were included in the review. Nine studies were of general practitioners’ (GPs) perspectives, one study of GPs and nurses working in nursing homes, one study of psychiatrists, and two of a mix of health professionals. Barriers and facilitators to discontinuing long-term AD emerged within six major themes: 'perception of long-term AD use', ‘intrinsic motivations’, ‘fears’, ‘HP role and responsibility, ‘patient readiness’, and 'process related and structural factors’.

Consequences

Barriers and facilitators for HP regarding discontinuation of long-term use of AD are numerous and complex. More emphasis on the futility of the actual effect and potential harms related to long-term use is needed to improve HPs' motivation to discontinue long-term AD. The review shows a need to support for GPs around their fear of patient relapse and to initiate discussion around discontinuation. Future studies should assess under-researched HP perspectives (such as pharmacist, psychotherapist, or nursing home staff).

Submitted by: 
Ellen Van Leeuwen
Funding acknowledgement: 
no funding