title: Long-term prescribing of antidepressants in the older population: a qualitative study.
abstract: BACKGROUND
  High rates of long-term antidepressant prescribing have been identified in the older population.
  
  
  OBJECTIVE
  To explore the attitudes of older patients and their GPs to taking long-term antidepressant therapy, and their accounts of the influences on long-term antidepressant use.
  
  
  METHODS
  Qualitative study using in-depth semi-structured interviews.
  
  
  METHODS
  One primary care trust in North Bradford.
  
  
  METHODS
  Thirty-six patients aged > or =75 years and 10 GPs were interviewed. Patients were sampled to ensure diversity in age, sex, antidepressant type, and home circumstances.
  
  
  RESULTS
  Participants perceived significant benefits and expressed little apprehension about taking long-term antidepressants, despite being aware of the psychological and social factors involved in onset and persistence of depression. Barriers to discontinuation were identified following four themes: pessimism about the course and curability of depression; negative expectations and experiences of ageing; medicine discontinuation perceived by patients as a threat to stability; and passive (therapeutic momentum) and active (therapeutic maintenance) decisions to accept the continuing need for medication.
  
  
  CONCLUSIONS
  There is concern at a public health level about high rates of long-term antidepressant prescribing, but no evidence was found of a drive for change either from the patients or the doctors interviewed. Any apprehension was more than balanced by attitudes and behaviours supporting continuation. These findings will need to be incorporated into the planning of interventions aimed at reducing long-term antidepressant prescribing in older people.
authors.affiliation: School of Healthcare, University of Leeds, Leeds.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dickinson
authors.forename: Peter
authors.initials: P
authors.lastname: Knapp
authors.forename: Allan O
authors.initials: AO
authors.lastname: House
authors.forename: Vandana
authors.initials: V
authors.lastname: Dimri
authors.forename: Arnold
authors.initials: A
authors.lastname: Zermansky
authors.forename: Duncan
authors.initials: D
authors.lastname: Petty
authors.forename: John
authors.initials: J
authors.lastname: Holmes
authors.forename: David K
authors.initials: DK
authors.lastname: Raynor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D032882:Comprehension; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004644:Emotions; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
chemical_list: D000928:Antidepressive Agents