Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care
Open accessAbstract
BACKGROUND: Antidepressant use is often prolonged in patients with anxiety and/or depressive disorder(s) compared with recommendations in treatment guidelines to discontinue after sustained remission. AIM: To unravel the motivations of patients and GPs causing long-term antidepressant use and to gain insight into possibilities to prevent unnecessary long-term use. DESIGN AND SETTING: Qualitative study using semi-structured, in-depth interviews with patients and GPs in the Netherlands. METHOD: Patients with anxiety and/or depressive disorder(s) (n = 38) and GPs (n = 26) were interviewed. Innovatively, the interplay between patients and their GPs was also investigated by means of patient-GP dyads (n = 20). RESULTS: The motives and barriers of patients and GPs to continue or discontinue antidepressants were related to the availability of supportive guidance during discontinuation, the personal circumstances of the patient, and considerations of the patient or GP. Importantly, dyads indicated a large variation in policies of general practices around long-term use and continuation or discontinuation of antidepressants. Dyads further indicated that patients and GPs seemed unaware of each other's (mismatching) expectations regarding responsibility to initiate discussing continuation or discontinuation. CONCLUSION: Although motives and barriers to antidepressant continuation or discontinuation were related to the same themes for patients and GPs, dyads indicated discrepancies between them. Discussion between patients and GPs about antidepressant use and continuation or discontinuation may help clarify mutual expectations and opinions. Agreements between a patient and their GP can be included in a patient-tailored treatment plan.
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GPs in Holland reported the same concerns about lack of sufficient information and dissatisfaction with guidance.
“The same concerns were reported by GPs in Holland.28,51”
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”
From Helping people discontinue long-term antidepressants: views of health professionals in UK primary care (2019) · cites this paper as [19]
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”
From Helping people discontinue long-term antidepressants: views of health professionals in UK primary care (2019) · cites this paper as [19]
Fear of destabilising currently well patients by discontinuing antidepressants has been evidenced in patients and GPs.
“HPs reported fear of destabilising currently well patients by discontinuing antidepressants; a fear which has been evidenced in patients and GPs.19 20 33”
From Helping people discontinue long-term antidepressants: views of health professionals in UK primary care (2019) · cites this paper as [19]
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”
From Helping people discontinue long-term antidepressants: views of health professionals in UK primary care (2019) · cites this paper as [19]
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References 30 · Cited by 76
- Authors
- Bosman, R. C., Huijbregts, K. M., Verhaak, P. F., Ruhé, H. G., van Marwijk, H. W., van Balkom, A. J., & Batelaan, N. M.
- Affiliations
- Amsterdam Public Health (NL)
- University Medical Center Groningen (NL)
- Venue
- British Journal of General Practice
- Published
- 2016-08-15
- Volume
- 66
- Issue
- 651
- Pages
- e708-e719
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC5033307
- OpenAlex
- W2516288241
- Cited by
- 76
- References
- 30
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 13 · 2020: 13 · 2019: 8 · 2018: 2 · 2017: 3 · 2016: 1
- FWCI
- 7.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by-nc)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ZonMw
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (016.126.059;)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- long-term antidepressant use, antidepressant discontinuation, patient perspectives, general practitioners, anxiety disorders, depressive disorders, primary care, patient expectations
- MeSH terms
- Adult, Antidepressive Agents, Anxiety Disorders, Attitude of Health Personnel, Depressive Disorder, Drug Administration Schedule, Humans, Long-Term Care, Netherlands, Practice Patterns, Physicians', Primary Health Care, Treatment Outcome, Qualitative Research, General Practice
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