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Cited by 31Mental Health Treatment and AccessPatient-Provider Communication in HealthcareTreatment of Major Depression

Helping people discontinue long-term antidepressants: views of health professionals in UK primary care

Open access
Bowers, Hannah M, Williams, Samantha J, Geraghty, Adam W A, Maund, Emma, O’brien, Wendy, Leydon, Geraldine, May, Carl R, Kendrick, Tony·2019·BMJ Open
DOI 10.1136/bmjopen-2018-027837PMC PMC6615882
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Abstract

Objective: The aims of this paper were to identify, characterise and explain clinician factors that shape decision-making around antidepressant discontinuation in UK primary care. Design: Four focus groups and three interviews were conducted and analysed using thematic analysis. Participants: Twenty-one general practitioners (GPs), four GP assistants, seven nurses and six community mental health team workers and psychotherapists took part in focus groups and interviews. Setting: Participants were recruited from seven primary care regions and two National Health Service Trusts providing community mental health services in the South of England. Results: Participants highlighted a number of barriers and enablers to discussing discontinuation with patients. They held a range of views around responsibility, with some suggesting it was the responsibility of the health professional (HP) to broach the subject, and others suggesting responsibility rested with the patients. HPs were concerned about destabilising the current situation, discussed how continuity and knowing the patient facilitated discontinuation talks, and discussed how confidence in their professional skills and knowledge affected whether they elected to raise discontinuation in consultations. Conclusions: Findings indicate a need to consider support for HPs in the management of antidepressant medication and discussions of discontinuation in particular. They may also benefit from support around their fears of patient relapse and awareness of when and how to initiate discussions about discontinuation with their patients.

AI snapshot

Written from the paper’s full text.

TL;DR

UK primary care health professionals described multiple barriers and enablers to discussing long-term antidepressant discontinuation, including contested responsibility, fear of destabilising stable patients, the importance of continuity, limited confidence and knowledge, and organisational/time constraints. They wanted clearer guidance and support, particularly around relapse fears and when and how to initiate discontinuation conversations.

Key findings

  • Five themes were identified: who is responsible for broaching discontinuation; risk of destabilising the current situation; continuity and knowing the patient; HP confidence in skills and knowledge; and organisational barriers and enablers.
  • HPs held differing views on responsibility: some thought the prescriber/GP should initiate discussions, others that patients should, and some described discontinuation as a shared decision; many acknowledged they did not initiate these conversations as much as they felt they ought to.
  • Barriers included fear of destabilising currently well patients, lack of confidence/knowledge about tapering, dissatisfaction with unclear or inaccessible guidance, time constraints in 10-minute consultations, and lack of continuity of care.
  • Facilitators included knowing the patient, continuity, and discussing discontinuation expectations at the initial prescription; HPs wanted more support and specific information on how to discontinue antidepressants.

Methods

  • Qualitative study using four focus groups and three semistructured interviews, analysed with thematic analysis drawing on constant comparison and informed by Normalisation Process Theory.
  • Participants were 38 health professionals: 21 GPs, 4 GP assistants, 7 nurses, and 6 community mental health team workers/psychotherapists, recruited from seven primary care regions and two NHS Trusts in the South of England between January and May 2017.
  • Focus groups had 7–10 participants and lasted 43–59 min; transcripts were coded in NVivo, with independent coding by a second researcher, team agreement on themes, and data saturation when no new codes emerged.

Limitations

  • Stated by the authors: focus groups may reduce openness, become polarised, or be influenced by dominant members; in one group of nine GPs, two members were more dominant and two spoke less frequently, so some views may be less well represented.
  • Stated by the authors: GPs were the largest group, and further research is needed on other professionals such as pharmacists, social workers, and care coordinators; none of the practices used practice pharmacists for discontinuation.
  • Evident from the text: the study reports only health professional perspectives from UK primary care in the South of England, with no patient outcomes or quantitative estimates of discontinuation behaviour.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmjopen-2018-027837

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 42 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Confidence in professional skills and knowledge affected whether HPs elected to raise discontinuation in consultations.

    “HPs were concerned about destabilising the current situation, discussed how continuity and knowing the patient facilitated discontinuation talks, and discussed how confidence in their professional skills and knowledge affected whether they elected to raise discontinuation in consultations.”
    Quote in the paperSubstantial claim
  • Findingown data

    Social workers, pharmacists, care coordinators and psychiatrists were mentioned as potential sources of additional support in stopping antidepressants, in some cases.

    “Social workers, pharmacists, care coordinators and psychiatrists were also mentioned as potential sources of additional support in stopping antidepressants, in some cases.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Taking a proactive approach to discontinuation was not always considered feasible in practice.

    “However, taking a proactive approach was not always considered feasible in practice; continuity may facilitate discussions of antidepressant withdrawal, although it is not always possible in primary care.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants highlighted a number of barriers and enablers to discussing discontinuation with patients.

    “Participants highlighted a number of barriers and enablers to discussing discontinuation with patients.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among the factors enabling discussion about discontinuation were knowing the patient and continuity of care.

    “Among the factors enabling discussion about discontinuation were knowing the patient and continuity of care.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 52
  • May combine two claims. 44

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Continuity may facilitate discussions of antidepressant withdrawal, although it is not always possible in primary care.

    “However, taking a proactive approach was not always considered feasible in practice; continuity may facilitate discussions of antidepressant withdrawal, although it is not always possible in primary care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HPs highlighted problems with relying on the patient to broach discontinuation, as many patients may not instigate these conversations.

    “However, HPs highlighted there are problems with relying on the patient to broach the issue. Two nurses and a psychotherapist acknowledged that many patients may not instigate these conversations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some HPs referred to discontinuation as a shared decision process, involving assessing the patient's capacity and negotiating a shared decision about whether to discontinue.

    “Some of the HPs referred to the discussion of discontinuation as a shared decision process. They talked about the need to assess the patient’s capacity in making decisions about withdrawal and negotiating with the patient to come to a shared decision about whether to discontinue.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Some HPs described it as easier to continue prescribing rather than raising discontinuation with patients and acknowledged a need to initiate more discussions with patients who may be eligible.

    “Some HPs described it being easier to continue prescribing rather than raising discontinuation with patients and acknowledged a need to initiate more discussions about discontinuation with patients who may be eligible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was an assumption among HPs that patients also do not want to risk upsetting the current situation if they are feeling well.

    “There was an assumption that patients also do not want to risk upsetting the current situation if they are feeling well.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    One GP suggested discontinuation must be a shared decision because GPs are currently unable to manage the amount of work involved due to organisational factors.

    “One GP also suggested it must be a shared decision as GPs are currently unable to manage the amount of work involved due to organisational factors which make having these conversations more challenging.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Continuity and knowing the patient facilitated discontinuation talks.

    “HPs were concerned about destabilising the current situation, discussed how continuity and knowing the patient facilitated discontinuation talks, and discussed how confidence in their professional skills and knowledge affected whether they elected to raise discontinuation in consultations.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Five themes were identified from the data analysis regarding barriers and facilitators to discussing antidepressant discontinuation with patients.

    “Five themes were identified from the data analysis regarding barriers and facilitators to discussing antidepressant discontinuation with patients (see figure 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Nurses have limitations regarding their authority and experience in managing medications, and patients are often signposted to their GP by their nurse.

    “Although nurses have been considered to play a role in these discussions, there is acknowledgement that there are limitations regarding their authority and experience in managing medications, and often patients are signposted to their GP by their nurse.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Patients may be reluctant to broach discontinuation due to expectations of how the doctor may respond or perceiving the doctor to be more knowledgeable about the situation.

    “One psychotherapist explained that patients may be reluctant to broach the subject due to expectations of how the doctor may respond, or perceiving the doctor to be more knowledgeable about the situation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Health professionals held a range of views around responsibility for broaching discontinuation, with some suggesting it was the health professional's responsibility and others suggesting it rested with patients.

    “They held a range of views around responsibility, with some suggesting it was the responsibility of the health professional (HP) to broach the subject, and others suggesting responsibility rested with the patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some participants, including GPs, thought it was the GP's responsibility to broach discontinuation, especially if a patient has been on medication long term and may not have considered stopping.

    “Some participants (including GPs) thought that it was the GP’s responsibility to broach the subject with patients; arguing that the person who prescribes the medication should be the person to initiate discussion of discontinuation. This was especially the case if a patient has been on the medication long term and may not have considered stopping.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HPs were concerned about instigating discontinuation discussions with currently well patients because they did not want to risk destabilising the current situation; continuing prescribing was considered less risky.

    “There were concerns about instigating discussions with patients who are currently well as they did not want to risk destabilising the current situation. It was considered less risky to continue prescribing.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A small number of HPs suggested it was the patient's responsibility to broach the subject of discontinuation and that this expectation should be set when antidepressants are first prescribed.

    “A small number of HPs suggested it was the patient’s responsibility to broach the subject and that this expectation should be set when antidepressants are first prescribed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Unlike previous research, this study included perspectives of non-general practitioner HPs.

    “Unlike previous research, this study included perspectives of non-general practitioner HPs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many health professionals were unfamiliar with NICE guidance on antidepressant discontinuation or were not using it.

    “They spoke about NICE guidance on antidepressant discontinuation, with many being unfamiliar with the guidance or not using them.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Despite GPs' awareness of the need to improve on the current situation, conversations about discontinuation are often not routinely being initiated.

    “However, despite GPs’ awareness of the need to improve on the current situation, these conversations about discontinuation are often not routinely being initiated.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Health professionals repeatedly noted the challenge of time constraints in practice and how this is often a barrier to both initiating and managing discontinuation due to ten minute consultations not being long enough, and not having the time for review appointments.

    “HPs repeatedly noted the challenge of time constraints in practice and how this is often a barrier to both initiating and managing discontinuation due to ten minute consultations not being long enough, and not having the time for review appointments.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    An important theme identified in the current paper is contention in terms of who is responsible for broaching the topic of discontinuation.

    “An important theme identified in the current paper is contention in terms of who is responsible for broaching the topic of discontinuation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Health professionals described being dissatisfied and, in one case, irritated by the current guidance on antidepressant discontinuation.

    “They described being dissatisfied and, in one case, irritated by the current guidance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Health professionals perceived that involvement in the initial prescription placed responsibility on the prescriber to prompt discontinuation later and provided an opportunity to discuss and set patient expectations around withdrawal.

    “Involvement in the initial prescription was perceived to place responsibility on the prescriber to prompt discontinuation later, and an opportunity to discuss and set patient expectations around withdrawal.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The majority of health professionals acknowledged that responsibility for broaching discontinuation may lie with the GP or be a shared decision with patients, but they indicated that they currently do not initiate these conversations as much as they feel they ought to.

    “While the majority of HPs acknowledged that the responsibility may lie with the GP or be a shared decision with patients, they indicated that they currently do not initiate these conversations as much as they feel they ought to.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Health professionals discussed a need for more support and information for themselves as well as for patients.

    “HPs discussed a need for more support and information for themselves as well as for patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Some health professionals reported a lack of confidence, knowledge and skill regarding antidepressant discontinuation, which could act as a barrier to broaching the subject of stopping with patients.

    “Some of the HPs reported a lack of confidence, knowledge and skill with regards to antidepressant discontinuation which could act as a barrier to broaching the subject of stopping with patients.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Health professionals highlighted that current guidance on antidepressant discontinuation is unclear (especially regarding tapering regimes), limited, not accessible and at times not applicable to real patients.

    “They highlighted that it is unclear (especially regarding tapering regimes), limited, not accessible and at times not applicable to real patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Health professionals mentioned that systems which adequately prompt medication reviews would be useful in broaching discontinuation with patients.

    “HPs also mentioned the role of computer systems, explaining that patients can get lost in the system and that systems which adequately prompt medication reviews would be useful in broaching discontinuation with patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A lack of continuity was reported, with patients seeing different practitioners each time, and these practitioners were at times providing inconsistent recommendations.

    “A lack of continuity was reported with patients seeing different practitioners each time, and these practitioners were at times providing inconsistent recommendations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Health professionals mentioned that patients can get lost in the computer system.

    “HPs also mentioned the role of computer systems, explaining that patients can get lost in the system and that systems which adequately prompt medication reviews would be useful in broaching discontinuation with patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There are a number of professionals who may be involved in discontinuation (eg, pharmacists, social workers and care coordinators).

    “However, we also identified that there are a number of professionals who may be involved in discontinuation (eg, pharmacists, social workers and care coordinators) and further research may be needed to explore these perspectives.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Health professionals report dissatisfaction with the current guidelines and acknowledge gaps in their own knowledge regarding antidepressant withdrawal.

    “HPs report dissatisfaction with the current guidelines and acknowledge gaps in their own knowledge regarding antidepressant withdrawal.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The current study has explored barriers to antidepressant discontinuation in detail in UK primary care health professionals and highlighted additional factors influencing decisions around discontinuation such as organisational barriers, a need for clearer guidance and a desire to know the patient well.

    “The current study has explored these barriers in detail in UK primary care health professionals and highlighted additional factors influencing decisions around discontinuation such as organisational barriers, a need for clearer guidance and a desire to know the patient well.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    When patients do not raise discontinuation, practitioners may assume the patient wants to continue treatment, and this mutual assumption may result in collusion to maintain the status quo.

    “One GP suggested that when patients do not raise the idea of discontinuation, practitioners may assume that the patient wants to continue treatment. This mutual assumption that the HP wants the patient to continue, and that the patient him/herself wants to continue, may result in a form of collusion to maintain the status quo.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Previous research with HPs looking at antidepressant discontinuation has reported that the main barrier is a lack of awareness of guidance on best practice in discontinuation.

    “Previous research with HPs looking at antidepressant discontinuation has reported that the main barrier is a lack of awareness of guidance on best practice in discontinuation.19”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Data saturation was determined when no new codes were emerging.

    “Data were assessed for saturation by SJW individually and across-group.30 Data saturation was determined when no new codes were emerging.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    SJW independently coded the seven transcripts using NVivo.

    “SJW independently coded the seven transcripts using NVivo, and a secondary analysis team (SJW, AWAG, HMB, GL and TK) met to agree a preliminary coding frame, which was then agreed by the whole team.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Prompting GPs to review patients eligible for withdrawal was tested in a trial in the Netherlands and found to be ineffective, with 6% of patients discontinuing antidepressants in the intervention group and 8% in the control group.

    “Prompting GPs to review patients eligible for withdrawal was tested in a trial in the Netherlands and found to be ineffective, with 6% of patients discontinuing antidepressants in the intervention group and 8% in the control group.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    To acknowledge potential group effects, free participation was encouraged by the facilitators by avoiding censorship and conformity.

    “To acknowledge potential ‘group’ effects (ie, participants being unaware of the degree to which other group members’ views represent their own experience), free participation was encouraged by the facilitators by avoiding censorship and conformity.25”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A debriefing was conducted by the two facilitators following each focus group to identify issues that may affect analysis and suggest possible modifications to the topic guide.

    “A debriefing was conducted by the two facilitators following each focus group to identify issues that may affect analysis (eg, domineering or quiet members) and suggest possible modifications to the topic guide.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Patients may experience withdrawal symptoms or relapse and require further treatment from their practitioner.

    “Further to this, patients may experience withdrawal symptoms or relapse and require further treatment from their practitioner.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Davies, 2018, A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?, Addict Behav

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Normalisation Process Theory identifies, characterises and explains key mechanisms that motivate and shape implementation processes.

    “Normalisation Process Theory (NPT) identifies, characterises and explains key mechanisms that motivate and shape implementation processes.24”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research identified a lack of awareness of patient expectations that HPs should initiate discussions of discontinuation as a barrier.

    “Other barriers include a lack of awareness of patient expectations that HPs should initiate discussions of discontinuation, the availability of alternative treatments, time constraints, and GP and patient fear of destabilising a currently well patient.19 20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 19 20

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The lack of continuity and inconsistent recommendations may act as a barrier to discussing discontinuation due to the perceived need to be familiar with a patient to discuss withdrawal, and the idea that responsibility for raising the topic of discontinuation lies with the health professional who initially prescribed the antidepressant.

    “This may act as a barrier to discussing discontinuation due to the perceived need to be familiar with a patient to discuss withdrawal, and the idea that the responsibility for raising the topic of discontinuation lies with the HP who initially prescribed the antidepressant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Previous studies on HP perspectives of antidepressant discontinuation were completed outside the UK, and one within a nursing home.

    “However, there is only limited evidence on the HP’s perspective of antidepressant discontinuation (in particular practice nurses and community mental health workers), and previous studies were completed outside of the UK, and one within a nursing home.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    When comparing antidepressant maintenance treatment to tapering with psychological support, long-term relapse rates for depression are comparable or in some cases lower for patients receiving psychological therapy.

    “However, when comparing antidepressant maintenance treatment to tapering with psychological support, long-term relapse rates for depression are comparable34–36 or in some cases lower for patients receiving psychological therapy.37 38”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [34] source

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    • cites [35] source

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    • cites [36] source

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    • cites 37 38

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A qualitative metasynthesis of patient and practitioner perspectives on antidepressant discontinuation highlighted a lack of consistent support and guidance for GPs.

    “A qualitative metasynthesis of patient and practitioner’s perspectives on antidepressant discontinuation highlighted a lack of consistent support and guidance for GPs and the impact of time constraints on discontinuation.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Maund E , Dewar-Haggart R , Williams S , et al . Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis. J Affect Disord 2019;245.doi:10.1016/j.jad.2018.10.107 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research identified time constraints as a barrier to antidepressant discontinuation.

    “Other barriers include a lack of awareness of patient expectations that HPs should initiate discussions of discontinuation, the availability of alternative treatments, time constraints, and GP and patient fear of destabilising a currently well patient.19 20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 19 20

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Depression and the long-term use of antidepressants are associated with reduced agency.

    “However, depression and the long-term use of antidepressants are associated with reduced agency.32”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Cartwright, 2018, Personal agency in women’s recovery from depression: the impact of antidepressants and women’s personal efforts, Clin Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research identified GP and patient fear of destabilising a currently well patient as a barrier to antidepressant discontinuation.

    “Other barriers include a lack of awareness of patient expectations that HPs should initiate discussions of discontinuation, the availability of alternative treatments, time constraints, and GP and patient fear of destabilising a currently well patient.19 20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 19 20

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research identified the availability of alternative treatments as a barrier to antidepressant discontinuation.

    “Other barriers include a lack of awareness of patient expectations that HPs should initiate discussions of discontinuation, the availability of alternative treatments, time constraints, and GP and patient fear of destabilising a currently well patient.19 20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 19 20

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Theme labelling and interpretation were continually discussed in regular team meetings.

    “Theme labelling and interpretation were continually discussed in regular team meetings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Codes were grouped into themes by SJW and HMB, where both within and between-participant variation was considered.

    “Codes were grouped into themes by SJW and HMB, where both within and between-participant variation was considered.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A qualitative metasynthesis of patient and practitioner perspectives on antidepressant discontinuation highlighted the impact of time constraints on discontinuation.

    “A qualitative metasynthesis of patient and practitioner’s perspectives on antidepressant discontinuation highlighted a lack of consistent support and guidance for GPs and the impact of time constraints on discontinuation.22”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Maund E , Dewar-Haggart R , Williams S , et al . Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis. J Affect Disord 2019;245.doi:10.1016/j.jad.2018.10.107 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The rise in antidepressant prescriptions is primarily due to GPs continuing to prescribe for longer, with the average length of treatment now more than 2 years.

    “This rise is primarily due to general practitioners (GPs) continuing to prescribe for longer,1 2 with the average length of treatment now at more than 2 years.3 4”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites 1 2

      Not checked in the free run.

    • cites 3 4

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Data were assessed for saturation by SJW individually and across-group.

    “Data were assessed for saturation by SJW individually and across-group.30 Data saturation was determined when no new codes were emerging.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    HMB independently coded two transcripts using the coding frame; discrepancies were minor and changes were made following discussion with the team.

    “HMB independently coded two transcripts using the coding frame; discrepancies were minor and changes were made following discussion with the team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    The use of focus groups facilitated group discussion, but the group setting may reduce openness.

    “The use of focus groups facilitated group discussion; however, it is possible that the group setting may reduce openness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The way primary care often operates does not lend itself to the desired context for discussing withdrawal, which results in a bias towards inaction.

    “The way primary care often operates therefore does not lend itself to the desired context for discussing withdrawal, which results in a bias towards inaction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Prompting alone is insufficient in supporting patients to discontinue antidepressants, indicating there are other factors preventing GPs from attempting to withdraw patients.

    “Prompting alone is therefore insufficient in supporting patients to discontinue antidepressants, which indicates there are other factors preventing GPs from attempting to withdraw patients from antidepressants.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] source

      Not checked in the free run.

    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is limited evidence in previous research on who initiates discontinuation conversations, with one study reporting that some GPs expect patients to contact their practitioner when they wish to make changes to or discontinue their antidepressant.

    “There is limited evidence of this in previous research with one study reporting that some GPs expect patients to contact their practitioner when they wish to make changes to or discontinue their antidepressant.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Focus groups were facilitated by two experienced female qualitative researchers.

    “Focus groups were facilitated by two experienced female qualitative researchers (SJW and WOB) and were audio recorded.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The logical implication of the barriers for patients and reduced agency is that GPs should take responsibility for initiating conversations about discontinuation.

    “The logical implication of this would be that GPs take the responsibility for initiating these conversations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    In current UK primary care, patients do not always see the same GP, and GPs therefore may be unable to build the desired relationship with or acquire the desired knowledge of a patient before broaching the subject of stopping antidepressants.

    “However, in current UK primary care, patients do not always see the same GP and GPs therefore may be unable to build the desired relationship with or acquire the desired knowledge of a patient before broaching the subject of stopping antidepressants.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A secondary analysis team met to agree a preliminary coding frame, which was then agreed by the whole team.

    “SJW independently coded the seven transcripts using NVivo, and a secondary analysis team (SJW, AWAG, HMB, GL and TK) met to agree a preliminary coding frame, which was then agreed by the whole team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Normalisation Process Theory focuses attention on the work that participants do when they seek to routinely incorporate components of complex interventions in their everyday lives.

    “It focuses attention on the work that participants in these processes do when they seek to routinely incorporate components of complex interventions in their everyday lives.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many patients on long-term antidepressant treatment are given repeat prescriptions and are reviewed infrequently.

    “This may be due to many patients on long-term treatment being given repeat prescriptions and being reviewed infrequently.9 10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 9 10

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    There is a need to provide improved guidance and enhanced accessibility to and awareness of guidance on discontinuation, including specific guidance on reducing the doses of different antidepressants.

    “This suggests a need to provide improved guidance and enhanced accessibility to and awareness of guidance on discontinuation, including specific guidance on reducing the doses of different antidepressants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In a focus group of nine GPs, there were two more dominant members and two members who spoke less frequently.

    “For example, in a focus group of nine GPs, there were two more dominant members and two members who spoke less frequently.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Some participants' views may be less well represented in a group setting.

    “As such, some participants’ views may be less well represented in a group setting.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The findings highlight a need to support health professionals in antidepressant discontinuation in terms of providing specific information and guidance on how to discontinue antidepressants.

    “Our findings highlight a need to support HPs in antidepressant discontinuation in terms of providing specific information and guidance on how to discontinue antidepressants.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The findings suggest health professionals would benefit from support and guidance around fears of patient relapse and awareness of the need to initiate discussions about discontinuation.

    “They also suggest HPs would benefit from support and guidance around fears of patient relapse and awareness of the need to initiate discussions about discontinuation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Previous research has highlighted time constraints and fear of relapse as barriers to GPs discontinuing antidepressants, and one previous study found that some GPs expected patients to initiate discussions of discontinuation.

    “Previous research has highlighted time constraints and fear of relapse as barriers to GPs discontinuing antidepressants and one previous study found that some GPs expected patients to initiate discussions of discontinuation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The use of focus groups facilitated discussion and provided candid responses from participants.

    “The use of focus groups facilitated discussion and provided candid responses from participants.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Increased confidence in the health professional's ability to manage discontinuation may help to lessen the health professional's fears around destabilisation and relapse.

    “This increased confidence in the HP ability to manage discontinuation may then also help to lessen the HP’s fears around destabilisation and relapse.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The study's sample was larger and consisted of a range of health professional roles (GPs, GP assistants, nurses, community mental health team workers and psychotherapists) which were lacking in previous research.

    “This study is the first to explore HP’s perspectives of antidepressant discontinuation in UK primary care, with its larger sample consisting of a range of HP roles (including GPs, GP assistants, nurses, community mental health team workers and psychotherapists) which were lacking in previous research,20 21 33 40 41 and data reached saturation.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] Johnson, 2017, ‘Doing the right thing’: factors influencing GP prescribing of antidepressants and prescribed doses, BMC Fam Pract source

      Not checked in the free run.

    • cites [21] Davies, 2018, A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?, Addict Behav

      Not checked in the free run.

    • cites [33] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One other study has highlighted that GPs feel guidelines could provide more specific information about antidepressant treatment and discontinuation.

    “One other study has highlighted that GPs feel guidelines could provide more specific information about antidepressant treatment and discontinuation.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data reached saturation.

    “This study is the first to explore HP’s perspectives of antidepressant discontinuation in UK primary care, with its larger sample consisting of a range of HP roles (including GPs, GP assistants, nurses, community mental health team workers and psychotherapists) which were lacking in previous research,20 21 33 40 41 and data reached saturation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    It is possible for focus group discussions to become polarised or influenced by dominant members of the group.

    “However, it is possible for discussions to become polarised or influenced by dominant members of the group.”
    Quote in the paperNot a substantial claim
77 of 77

  • The paper relies on this without support.

    Insights into UK primary care health professionals' perspectives are needed to determine barriers and facilitators to supporting patients in discontinuing antidepressants in the UK.

    “Insights into UK primary care HP’s perspectives are therefore needed to determine barriers and facilitators to supporting patients in discontinuing antidepressants in the UK.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Table column totals do not add up to the reported sample size

    Minor

    The focus-group and interview totals in the table add to 37, not the reported 38. This follows from the incorrect focus group 4 total.

    Reported 38 · recomputed 37

  • Focus group 4 total is one below its participant count

    Minor

    The table lists nine GPs and no other participants in focus group 4, but gives its total as eight.

    Reported 8 · recomputed 9

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Glaser BG . Theoretical sensitivity. Mill Valley CA: Sociology Press, 1978.
  2. Pollock, 2002, Primary care practice consultations for depression : qualitative study, Prim Care, 325, 687

Cited by

Sorted by citations

Related

Authors
Bowers, H. M., Williams, S. J., Geraghty, A. W. A., Maund, E., O’brien, W., Leydon, G., May, C. R., & Kendrick, T.
Affiliations
  • University of Southampton (GB)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Bowers, Hannah M
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-07
Volume
9
Issue
7
Pages
e027837
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2018-027837
PMC
PMC6615882
OpenAlex
W2955480450
Semantic Scholar
1536d100c8d6b21b47a57a61bf868796d3968388
Cited by
31
References
37
Citations by year
2026: 2 · 2025: 10 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 5 · 2020: 6
FWCI
3.77
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Programme Grants for Applied Research
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
antidepressant discontinuation, clinician decision-making, primary care, general practitioners, community mental health services, barriers and facilitators, clinician confidence, continuity of care, patient responsibility, clinician support
MeSH terms
Antidepressive Agents, Depressive Disorder, Drug Administration Schedule, England, Female, Health Personnel, Humans, Interviews as Topic, Health Knowledge, Attitudes, Practice, Male, Primary Health Care, Focus Groups, Qualitative Research, General Practice

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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