Patient and Health Professional experiences of reducing antidepressant medication as part of the REDUCE feasibility RCT

Problem

There is considerable concern about increasing antidepressant use in England. GPs are writing more than 60 million prescriptions a year, to around 1-in-10 adults. Some people need long-term antidepressants to stop them getting depressed, but a third-to-a-half could possibly stop them without relapsing. However, stopping can be difficult with some patients experiencing withdrawal symptoms, while others may be fearful that they will experience them. There are good reasons for proposing that antidepressants should not be continued long-term unless absolutely necessary, but patients can be fearful and cessation can be difficult. The NHS funded six-year REviewing long term antiDepressant Use by Careful monitoring in Everyday practice (REDUCE) research programme aims to identify feasible, safe, effective, and cost-effective ways of helping patients taking long-term antidepressants taper off and stop treatment, when appropriate. This Work Stream 4 (WS4) of the REDUCE programme aims to determine the feasibility of a randomised controlled trial of a web-based intervention which supports practitioners and guides patients on coming off antidepressants, together with telephone calls with psychological practitioners to support the patients through this process.

Approach

Semi-structured qualitative interviews were conducted with 18 patients and 10 health professionals currently taking part in the REDUCE study at different time points. Thematic analysis of these interviews is underway, and additional analysis is being conducted utilising Normalisation Process Theory (NPT).

Findings

A summary of findings will be reported at the conference. Early analysis suggests a positive response to the study from both patients and health professionals and that recruitment methods have worked well. Health professionals report that GP time and patient continuity were the main barriers to recruitment. Patients reported that taking part in the study resulted in improved motivation and confidence to stop antidepressants by providing the opportunity to ‘think about’ their medication and improve self-awareness. Some participants have also suggested that they were surprised at how easy cessation could be, and that the programme enabled a safe and guided approach to stopping. However, patients randomised to the control arm expressed some disappointment at the lack of support to taper off and stop antidepressant use.

Consequences

Findings from this study have contributed to improving the REDUCE intervention website, provision of phone call support, and study recruitment for the full RCT. Further NPT analysis will inform how implementation of the REDUCE intervention works in practice and how this can be improved and implemented in the next REDUCE programme Work Stream (WS5, full RCT).