Insights into weaning patients off antidepressants

Paul Hayes

20/04/2021 2:30:22 PM

Discontinuing long-term antidepressant use should only occur after thorough preparation between a patient and their GP, new research has found.

Young man looking at pill packet
The study suggests GPs need clinical time to engage with patients on decision-making regarding discontinuing antidepressants.

A new qualitative study from the University of Queensland (UQ) has found that despite GPs understanding the challenges, many believe there is no standardised approach to discontinuing antidepressants.
‘It begins with considering a patient’s social and relational context, and is a journey involving careful preparation, tailored care and regular review,’ Associate Professor Riitta Partanen from UQ’s Rural Clinical School said.
‘Stopping unnecessary long-term use needs to start at initiation, and GP education and training must give adequate attention to prescribing, repeat prescribing and deprescribing.
‘The study suggests GPs need the clinical time to engage with patients with decision-making around prescribing and discontinuing antidepressants.’
The study was based on interviews with 22 GPs working in urban and regional areas.
According to Associate Professor Partanen, the research adds to evidence that repeat prescriptions occur within a complex medical and relational setting, showing ‘the complex decision-making GPs undertake in determining whether a patient is ready to discontinue’.
‘They’re never just administrative encounters to get a script,’ Dr Partanen said.
‘The study captures a set of steps GPs take together with their patients to initiate and set up adequate support before, during and after discontinuation.’
Australia has a history of antidepressant use.
Data indicates one in eight Australians – more than three million people – are on antidepressants, while anxiety and depression medication rates spiked amid ongoing uncertainty of last year’s COVID-driven lockdowns.
Last year also saw an antidepressant become one of Australia’s most commonly prescribed drugs for the first time, with Sertraline – sold as Zoloft – entering Australian Prescriber’s top 10 most commonly taken medications on a standard daily-dose basis.
Dr Partanen said other previous work in this area has shown a rise in long-term antidepressant use, with most prescriptions taking place in general practice. 

‘About one third of long-term users have no clear reason for continued use,’ she said. 

‘So there is scope within primary care for careful treatment re-evaluation and discontinuation of antidepressants.’ 
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