title: Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care.
abstract: BACKGROUND
  Antidepressant use is often prolonged in patients with anxiety and/or depressive disorder(s) compared with recommendations in treatment guidelines to discontinue after sustained remission.
  
  
  OBJECTIVE
  To unravel the motivations of patients and GPs causing long-term antidepressant use and to gain insight into possibilities to prevent unnecessary long-term use.
  
  
  METHODS
  Qualitative study using semi-structured, in-depth interviews with patients and GPs in the Netherlands.
  
  
  METHODS
  Patients with anxiety and/or depressive disorder(s) (n = 38) and GPs (n = 26) were interviewed. Innovatively, the interplay between patients and their GPs was also investigated by means of patient-GP dyads (n = 20).
  
  
  RESULTS
  The motives and barriers of patients and GPs to continue or discontinue antidepressants were related to the availability of supportive guidance during discontinuation, the personal circumstances of the patient, and considerations of the patient or GP. Importantly, dyads indicated a large variation in policies of general practices around long-term use and continuation or discontinuation of antidepressants. Dyads further indicated that patients and GPs seemed unaware of each other's (mismatching) expectations regarding responsibility to initiate discussing continuation or discontinuation.
  
  
  CONCLUSIONS
  Although motives and barriers to antidepressant continuation or discontinuation were related to the same themes for patients and GPs, dyads indicated discrepancies between them. Discussion between patients and GPs about antidepressant use and continuation or discontinuation may help clarify mutual expectations and opinions. Agreements between a patient and their GP can be included in a patient-tailored treatment plan.
authors.affiliation: Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, and GGZinGeest, Amsterdam.
authors.forename: Renske C
authors.initials: RC
authors.lastname: Bosman
authors.affiliation: Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, and Prezens Mental Health, Amsterdam.
authors.forename: Klaas M
authors.initials: KM
authors.lastname: Huijbregts
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, and NIVEL, Netherlands Institute of Health Services Research, Utrecht.
authors.forename: Peter Fm
authors.initials: PF
authors.lastname: Verhaak
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Psychiatry, Mood and Anxiety Disorders, Groningen.
authors.forename: Henricus G
authors.initials: HG
authors.lastname: Ruhé
authors.affiliation: Manchester Academic Health Sciences Centre and NIHR School for Primary Care Research, Manchester.
authors.forename: Harm Wj
authors.initials: HW
authors.lastname: van Marwijk
authors.affiliation: Department of Psychiatry and EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam.
authors.forename: Anton Jlm
authors.initials: AJ
authors.lastname: van Balkom
authors.affiliation: Department of Psychiatry and EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam.
authors.forename: Neeltje M
authors.initials: NM
authors.lastname: Batelaan
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D001291:Attitude of Health Personnel; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D004334:Drug Administration Schedule; D058006:General Practice; D006801:Humans; D008134:Long-Term Care; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D036301:Qualitative Research; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: antidepressants; anxiety disorder; continuation; depressive disorder; discontinuation; general practitioners; long-term use; patient perspective