TY - JOUR
T1 - Health care professional barriers and facilitators to discontinuing antidepressant use
T2 - A systematic review and thematic synthesis
AU - Van Leeuwen, Ellen
AU - Maund, Emma
AU - Woods, Catherine
AU - Bowers, Hannah
AU - Christiaens, Thierry
AU - Kendrick, Tony
N1 - Publisher Copyright:
© 2024
PY - 2024/7/1
Y1 - 2024/7/1
N2 - 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.
AB - 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.
KW - Antidepressants
KW - Depression
KW - Discontinuation
KW - Health care professionals
KW - Qualitative systematic review
UR - http://www.scopus.com/inward/record.url?scp=85190981929&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2024.04.060
DO - 10.1016/j.jad.2024.04.060
M3 - Review article
C2 - 38640978
AN - SCOPUS:85190981929
SN - 0165-0327
VL - 356
SP - 616
EP - 627
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -