Health care professional barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis
Health care professional barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis
Introduction: long-term antidepressant (AD) use, much longer than recommended, is very common and can lead to potential harms.
Objective: to investigate the existing literature on perspectives of health professionals (HPs) regarding long-term AD treatment, focusing on barriers and facilitators to discontinuation.
Methods: a systematic review with thematic synthesis. Eight electronic databases were searched until August 2023 including MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, and the Networked Digital Library of Theses and Dissertation.
Results: thirteen studies were included in the review. Of these, nine focused on general practitioner perspectives, one on psychiatrist perspectives, and three on a mix of HPs perspectives. Barriers and facilitators to discontinuing long-term ADs emerged within eight themes, ordered chronologically based on HP considerations during an AD review: perception of AD use, fears, HP role and responsibility, HPs' perception of AD discontinuation, HPs' confidence regarding their ability to manage discontinuation, perceived patient readiness to stop, support from patient's trusted people, and support from other HPs.
Limitations: coding and development of subthemes and themes was performed by one researcher and further developed through discussion within the research team.
Conclusion: deprescribing long-term ADs is a challenging concept for HPs. The review found evidence that the barriers far outweigh the facilitators with fear of relapse as a main barrier. HP education, reassurance and confidence-building is essential to increase the initiation of the discontinuation process. Further research into the perspectives of pharmacists and mental health workers is needed as well as exploring the role of trusted people.
Antidepressants, Depression, Discontinuation, Health care professionals, Qualitative systematic review
616-627
Van Leeuwen, Ellen
c2de311a-3a69-4375-9039-11f28b593062
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Woods, Catherine
239255f5-6dfe-43c4-9650-56ee03f2b06c
Bowers, Hannah
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Christiaens, Thierry
4994839c-3b12-4df6-b8cc-1522cb03caf5
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
1 July 2024
Van Leeuwen, Ellen
c2de311a-3a69-4375-9039-11f28b593062
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Woods, Catherine
239255f5-6dfe-43c4-9650-56ee03f2b06c
Bowers, Hannah
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Christiaens, Thierry
4994839c-3b12-4df6-b8cc-1522cb03caf5
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Van Leeuwen, Ellen, Maund, Emma, Woods, Catherine, Bowers, Hannah, Christiaens, Thierry and Kendrick, Tony
(2024)
Health care professional barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis.
Journal of Affective Disorders, 356, .
(doi:10.1016/j.jad.2024.04.060).
Abstract
Introduction: long-term antidepressant (AD) use, much longer than recommended, is very common and can lead to potential harms.
Objective: to investigate the existing literature on perspectives of health professionals (HPs) regarding long-term AD treatment, focusing on barriers and facilitators to discontinuation.
Methods: a systematic review with thematic synthesis. Eight electronic databases were searched until August 2023 including MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, and the Networked Digital Library of Theses and Dissertation.
Results: thirteen studies were included in the review. Of these, nine focused on general practitioner perspectives, one on psychiatrist perspectives, and three on a mix of HPs perspectives. Barriers and facilitators to discontinuing long-term ADs emerged within eight themes, ordered chronologically based on HP considerations during an AD review: perception of AD use, fears, HP role and responsibility, HPs' perception of AD discontinuation, HPs' confidence regarding their ability to manage discontinuation, perceived patient readiness to stop, support from patient's trusted people, and support from other HPs.
Limitations: coding and development of subthemes and themes was performed by one researcher and further developed through discussion within the research team.
Conclusion: deprescribing long-term ADs is a challenging concept for HPs. The review found evidence that the barriers far outweigh the facilitators with fear of relapse as a main barrier. HP education, reassurance and confidence-building is essential to increase the initiation of the discontinuation process. Further research into the perspectives of pharmacists and mental health workers is needed as well as exploring the role of trusted people.
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Accepted/In Press date: 14 April 2024
e-pub ahead of print date: 17 April 2024
Published date: 1 July 2024
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© 2024
Keywords:
Antidepressants, Depression, Discontinuation, Health care professionals, Qualitative systematic review
Identifiers
Local EPrints ID: 491004
URI: http://eprints.soton.ac.uk/id/eprint/491004
ISSN: 0165-0327
PURE UUID: 8dea0614-7fc2-4e34-9042-50adff0edf58
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Date deposited: 11 Jun 2024 16:36
Last modified: 12 Jul 2024 01:57
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Author:
Ellen Van Leeuwen
Author:
Catherine Woods
Author:
Thierry Christiaens
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