Exploration of GP perspectives on deprescribing antidepressants: a qualitative study

Abstract

Objective: Our aim was to explore general practitioners' (GPs) perceptions and experiences of discontinuing antidepressants.

Study design: A qualitative study using semistructured interviews was undertaken between July 2019 and March 2020. The interviews were transcribed and analysed using a thematic analysis framework.

Setting: GPs affiliated with a university education and research network for general practice in Ireland.

Participants: A purposive sample of GPs (n=10).

Results: Five themes emerged: shared decision-making; personalised therapy; medication-tapering toolkit; health service factors and concerns around tapering. GPs described being less likely to engage in deprescribing for patients with long-term and/or recurrent depression, older patients and those with comorbidities due to fear of relapse. Access to evidence-based psychological therapies, guidelines, information on rates of relapse, patient leaflets on discontinuing antidepressants and reminder prompts on GP-prescribing software were suggested to optimise appropriate antidepressant discontinuation. There was some suggestion that patients may use antidepressants for longer when talk therapy is not available or taken up.

Conclusions: GPs are largely confident in their role of managing mild-to-moderate depression and deprescribing antidepressants. This study provides an insight into factors that influence GPs' decisions to deprescribe antidepressants. More information on rates of relapse after discontinuation would be helpful to inform decision-making.

Keywords: depression & mood disorders; primary care; qualitative research; quality in healthcare.