Efficacy of usual care to support safe antidepressant withdrawal in English GP practices
Sarah Jones, University of Bristol
Background
Antidepressants can be a safe and effective treatment for depression, but they are often only needed for a limited time. Most antidepressants (95%) are prescribed and managed by staff working in GP practices (not specialist mental health services). The number of people prescribed these medicines is rising and people are taking them for longer.
One problem with antidepressants is that some people have unpleasant withdrawal reactions when they’re stopped. Not everyone has these reactions and those that do report a wide range of effects from mild to very severe. Currently we do not know precisely how often withdrawal reactions occur, but some research studies suggest that up to half of patients have some difficulties when stopping. The withdrawal effects include anxiety, feeling sick, severe restlessness, headaches and electric-shock sensations.
GPs and other prescribers do not always recognise antidepressant withdrawal when it occurs. There is guidance on how to lower the risk of patients experiencing withdrawal symptoms (for example, by reducing antidepressants slowly) but, having talked to patients, we are aware this advice is not always followed. Some patients still have antidepressants stopped abruptly or are not taken seriously when they report withdrawal effects.
Aim
To assess patients’ and prescribers’ experiences of reducing and stopping antidepressants in GP practices to understand how this process could be better managed in the future.
Objectives
- To explore what happens when patients want to stop their antidepressant, including whether medication is reduced slowly, whether they experience withdrawal effects and what they think about the care they receive.
- To find out what proportion of patients have successfully stopped their antidepressant within 6-months of deciding they want to stop.
- To explore how other prescribers working in GP practices (like pharmacists or nurses) could have a greater role in supporting patients reduce their antidepressants
- To identify patient, prescriber or medication related factors that improve the chances of someone being able to stop their antidepressant without experiencing significant problems.
Methods
We will recruit patients from GP practices who want to stop their antidepressant and follow them up over 6-months. They will be asked to record their experiences using questionnaires at 1,3, and 6-months. Information from their clinical records will also be collected to see what they were prescribed, what advice they receive and whether they need follow-up appointments or referrals.
At the end of the study we will interview some of the patients to find out more about their experiences and views about stopping heir antidepressant.
We will also recruit prescribers with experience of prescribing antidepressant reductions to find out their views on what works well, what the problems are, and how things could be improved.
Sharing Results and Impact
Our results will be published in academic journals and shared through clinical and patient networks. By better understanding the experiences of prescribers and patients, we will be able to make practical recommendations to improve care in the future and allow more patients to successfully stop their antidepressant when they are ready to do so.
