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Barriers and facilitators to discontinuing antidepressant use: a systematic review and thematic synthesis

Barriers and facilitators to discontinuing antidepressant use: a systematic review and thematic synthesis
Barriers and facilitators to discontinuing antidepressant use: a systematic review and thematic synthesis
Objective
To explore patient and health professional views and experiences of antidepressant treatment with particular focus on barriers and facilitators to discontinuing use.

Design
Systematic review with thematic synthesis.

Data sources
MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, OpenGrey, and the Networked Digital Library of Theses and Dissertations from inception until February 2017. Updated searches were carried out in July 2018.

Eligibility criteria
Primary studies, published in English, that used qualitative data collection and analysis, and had data on attitudes, beliefs, feelings, perceptions on continuing or discontinuing antidepressant use, of patients (aged 18 or above, who received treatment with antidepressants for at least 6 months) or any health professionals.

Data extraction
One reviewer extracted data and assessed study quality, which was checked by a second reviewer.

Findings
Twenty two papers were included in the review. A thematic synthesis was performed for patient perspectives only, due to insufficient data from a health professional perspective. The thematic synthesis yielded nine themes: (1) psychological and physical capabilities; (2) perception of antidepressants; (3) fears; (4) intrinsic motivators and goals; (5) the Doctor as a navigator to maintenance or discontinuation; (6) perceived cause of depression; (7) aspects of information that support decision-making; (8) significant others – a help or a hindrance; and (9) support from other health professionals.

Limitations
Coding and development of subthemes and themes was performed by one researcher and further developed through discussion between two researchers.

Conclusions
Barriers and facilitators to discontinuing antidepressant use are numerous and complex, and likely to require detailed conversations between patients and their general practitioners (GPs). These conversations are more likely to happen if GPs raise the issue of discontinuation. Further research from a health professional perspective including, but not limited to GPs, is needed.
0165-0327
38-62
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Dewar-Haggart, Rachel
7ae70377-352a-4297-9798-a6aed0e1c04b
Williams, Samantha
7cec7c3e-7247-473e-8121-f26b625893e1
Bowers, Hannah
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Dawson, Sarah
1689f00c-c088-4e64-85f4-253e727b05ec
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Dewar-Haggart, Rachel
7ae70377-352a-4297-9798-a6aed0e1c04b
Williams, Samantha
7cec7c3e-7247-473e-8121-f26b625893e1
Bowers, Hannah
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Dawson, Sarah
1689f00c-c088-4e64-85f4-253e727b05ec
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5

Maund, Emma, Dewar-Haggart, Rachel, Williams, Samantha, Bowers, Hannah, Geraghty, Adam, Leydon, Geraldine, May, Carl, Dawson, Sarah and Kendrick, Tony (2019) Barriers and facilitators to discontinuing antidepressant use: a systematic review and thematic synthesis. Journal of Affective Disorders, 245, 38-62. (doi:10.1016/j.jad.2018.10.107).

Record type: Article

Abstract

Objective
To explore patient and health professional views and experiences of antidepressant treatment with particular focus on barriers and facilitators to discontinuing use.

Design
Systematic review with thematic synthesis.

Data sources
MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, OpenGrey, and the Networked Digital Library of Theses and Dissertations from inception until February 2017. Updated searches were carried out in July 2018.

Eligibility criteria
Primary studies, published in English, that used qualitative data collection and analysis, and had data on attitudes, beliefs, feelings, perceptions on continuing or discontinuing antidepressant use, of patients (aged 18 or above, who received treatment with antidepressants for at least 6 months) or any health professionals.

Data extraction
One reviewer extracted data and assessed study quality, which was checked by a second reviewer.

Findings
Twenty two papers were included in the review. A thematic synthesis was performed for patient perspectives only, due to insufficient data from a health professional perspective. The thematic synthesis yielded nine themes: (1) psychological and physical capabilities; (2) perception of antidepressants; (3) fears; (4) intrinsic motivators and goals; (5) the Doctor as a navigator to maintenance or discontinuation; (6) perceived cause of depression; (7) aspects of information that support decision-making; (8) significant others – a help or a hindrance; and (9) support from other health professionals.

Limitations
Coding and development of subthemes and themes was performed by one researcher and further developed through discussion between two researchers.

Conclusions
Barriers and facilitators to discontinuing antidepressant use are numerous and complex, and likely to require detailed conversations between patients and their general practitioners (GPs). These conversations are more likely to happen if GPs raise the issue of discontinuation. Further research from a health professional perspective including, but not limited to GPs, is needed.

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Maund 2018 Barriers and facilitators to discontinuing AD use main document - Author's Original
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More information

Accepted/In Press date: 16 October 2018
e-pub ahead of print date: 17 October 2018
Published date: 15 February 2019

Identifiers

Local EPrints ID: 425405
URI: http://eprints.soton.ac.uk/id/eprint/425405
ISSN: 0165-0327
PURE UUID: 4d9a716b-49b4-433a-9c92-ebde48682851
ORCID for Emma Maund: ORCID iD orcid.org/0000-0002-3998-6669
ORCID for Rachel Dewar-Haggart: ORCID iD orcid.org/0000-0002-3757-1152
ORCID for Samantha Williams: ORCID iD orcid.org/0000-0001-9505-6485
ORCID for Adam Geraghty: ORCID iD orcid.org/0000-0001-7984-8351
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

Catalogue record

Date deposited: 18 Oct 2018 16:30
Last modified: 16 Mar 2024 07:11

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Contributors

Author: Emma Maund ORCID iD
Author: Hannah Bowers
Author: Adam Geraghty ORCID iD
Author: Carl May ORCID iD
Author: Sarah Dawson
Author: Tony Kendrick ORCID iD

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