How do people make decisions about whether to continue or discontinue taking long-term antidepressants for depression? A critical interpretive synthesis

Abstract

Southampton-led research using the CPRD database has shown that the prevalence of depression rose by only 3.9% between 2009 and 2013, while the number of prescriptions rose by 36% over the same period, which is due to the rise of long-term antidepressant use.

While some long-term treatment of depression may be indicated according to evidence-based depression guidelines, much of it may be inappropriate, as some individuals are defined by having at least one key symptom of depression, but with insufficient other symptoms and/or functional impairment to meet the full diagnosis of major depression. Given the evidence that GPs are prescribing longer courses of antidepressant treatment, it has been recommended that guidelines need to include more information on how recurrent and long-term depression should be managed in primary care.

Up to a half of patients on long-term antidepressants have no clinical indications to continue medical treatment. There is concern that few review consultations are carried out with patients who are long-term antidepressant users, with the percentage of patients reviewed during each year of antidepressant therapy decreasing over 10 years. There are no formal processes within primary care for GPs to follow in order to carry out these reviews. Reviewing long-term antidepressant use can reduce drug burden.

The evidence suggests that the way in which longer-term depression is managed and reviewed in primary care should be explored. Furthermore, it is important to explore what factors may influence individuals’ decisions to continue or discontinue long-term antidepressant treatment for their depression.

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Identifiers

ORCID for Rachel Dewar-Haggart: orcid.org/0000-0002-3757-1152

ORCID for Tony Kendrick: orcid.org/0000-0003-1618-9381

ORCID for Ingrid Muller: orcid.org/0000-0001-9341-6133

ORCID for Felicity Bishop: orcid.org/0000-0002-8737-6662

ORCID for Adam Geraghty: orcid.org/0000-0001-7984-8351

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