Long-term antidepressant use: a qualitative study on perspectives of patients and GPs

Background: Antidepressant use is frequently prolonged in patients with anxiety and/or depressive disorder(s) compared to recommendations in treatment guidelines to discontinue after sustained remission.
Aims: To unravel motivations of patients and general practitioners (GPs) causing long-term antidepressant use and to gain insight in 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, also the interplay between patients and their GPs was investigated by means of patient-GP dyads (n=20).
Results: Motives and barriers of patients and GPs to continue/discontinue antidepressants were related to supportive guidance during discontinuation, personal circumstances of the patient and considerations of the patient/GP. Importantly, dyads indicated large variation in policies of GP-practices around long-term use and continuation/discontinuation of antidepressants. Dyads further indicated that patients and GPs seemed unaware of each other’s (mismatching) expectations regarding responsibility to initiate discussing continuation/discontinuation.
Conclusion: Although motives and barriers to antidepressant continuation/discontinuation were for patients and GPs related to the same themes, dyads indicated discrepancies between them. Discussion between patients and GPs about antidepressant use and continuation/discontinuation may help clarify mutual expectations and opinions. Agreements between a patient and his/her GP can be included in a patient-tailored treatment plan.