Evaluating the clinical and cost effectiveness of an online support tool to help reduce antidepressant medication use where there is no longer a clinical need. The WiserAD Study

Problem

The use of antidepressants is increasing globally, and Australia is no exception, having one of the highest rates of prescribing in the world. Despite the clear benefits of antidepressants for many people, there is reason to believe that ongoing use of these medications are often not properly monitored or deprescribed when a person’s mental health improves. This has led to potential personal and societal cost burdens.

This single blind, 1-1, parallel-arm randomized controlled trial sets out to test the clinical and cost effectiveness of an online support tool to help patients and their general practitioner to manage the careful and appropriate tapering and cessation of antidepressants, in primary care.

Approach

312 patients with mild or no symptoms of depression and who have been taking antidepressants for longer than 12m will be recruited through GPs. Consenting patients will be randomized into either the active arm where they will be asked to reduce their medication with the aid of a digital, clinically guided support tool. Those allocated to comparison arm will be provided with information about antidepressants through the beyondblue website (a federal and state funded independent mental health organisation in Australia). Both groups will be followed up at 3,6,12,18 months in order to record ongoing levels of depression, anxiety and quality of life. Health economic information will also be collected.

Findings

Statistical analysis will be used to determine the clinical effectiveness of the online tool where the primary outcome will be measured through the successful cessation of medication at 6 months and levels of depression remain mild or absent. An economic evaluation will be conducted to determine the cost effectiveness of the intervention and its’ impact on quality of life, compared to usual care.

Consequences

It is expected that the use of an online support tool to assist patients and their GP with the deprescribing will lead to the successful cessation of antidepressant medication, resulting in an enhanced quality of life and cost saving over the longer term, compared to treatment as usual.