“Never change a winning team”: GPs’ perspectives on discontinuation of long-term antidepressants

Ellen Van Leeuwen, Sibyl Anthierens, Mieke Van Driel, An De Sutter, Evelien Vandenbranden, Thierry Christiaens

Keywords: Long-term antidepressants, discontinuation, General Practitioner, depressive disorder, anxiety disorder, qualitative review

Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs. Most antidepressants are prescribed by general practitioners (GPs) but it remains unclear why they do not discontinue long-term use.

Research questions:
To explore GPs’ views and experiences of discontinuing long-term antidepressants, barriers and facilitators of discontinuation and required support.

20 semi-structured face to face interviews with GPs. Interviews were analysed thematically.

The first theme, ‘Success stories’ describes three strong motivators to discontinue antidepressants: patient health issues, patient request and a new positive life event. Second, not all GPs consider long-term antidepressant use a ‘problem’ as they perceive antidepressants as effective and safe. GPs’ main concern is risk of relapse. Third, GPs foresee that discontinuation of antidepressants is not an easy and straightforward process. GPs weigh up whether they have the necessary skills and whether it is worth the effort to start this process.

Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs, especially in the absence a facilitating life-event or patient demand. Absence of a compelling need for discontinuation and fear of relapse of symptoms in a stable patient, are important barriers for GPs when considering discontinuation. In order to increase GPs’ motivation to discontinue long-term antidepressants, more emphasis on the futility of the actual effect and on potential harms related to long-term use is needed.

Points for discussion:
is discontinuation of long-term AD necessary?

what to do with patients with long-term antidepressants with difficult life circumstances

is discontinuation similar to bringing bad news?