Barriers to discontinuing antidepressants in patients with depressive and anxiety disorders: a review of the literature and clinical recommendations

Scholten, Willemijn; Batelaan, Neeltje M.; Balkom, Anton van

doi:10.1177/2045125320933404

Cited by 11 publications

(12 citation statements)

References 58 publications

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“…The MacCAT-T follows a functional approach by measuring the ability to form a self-determined decision on a specific treatment at a specific time and context, independent of the presence of mental disorders (Grisso & Appelbaum, 1998;Scholten et al, 2020). Grisso et al (1997) propose to classify patients as 'impaired' as soon as one of the four MacCAT-T domains is rated two standard deviations below their healthy validation sample.…”

Section: Macarthur Competence Assessment Tool For Treatment (Maccat-t)mentioning

confidence: 99%

“…It is a semi‐structured interview that comprises four CCT domains: (1) understanding of disease, treatment and treatment‐related risks and benefits; (2) appreciating the insight into the disease and treatment; (3) reasoning about the consequences of a treatment decision; and (4) making and expressing a choice (Grisso & Appelbaum, 1998; Grisso et al, 1997). The MacCAT‐T follows a functional approach by measuring the ability to form a self‐determined decision on a specific treatment at a specific time and context, independent of the presence of mental disorders (Grisso & Appelbaum, 1998; Scholten et al, 2020). Grisso et al (1997) propose to classify patients as ‘impaired’ as soon as one of the four MacCAT‐T domains is rated two standard deviations below their healthy validation sample.…”

Section: Introductionmentioning

confidence: 99%

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Capacity to consent to psychotherapy: Reliability of the newly adapted German version of the MacArthur Competence Assessment Tool for Treatment for psychotherapy

Ladwig,

Pauls,

Gerke

et al. 2023

Clin Psychology and Psychoth

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BackgroundPatients' capacity to consent to treatment (CCT) is a prerequisite for ethically sound informed consent in psychotherapy. The MacArthur Competence Assessment Tool for Treatment (MacCAT‐T) is a reliable instrument for assessing CCT. A German version was adapted to the psychotherapeutical context (MacCAT‐PT) to investigate its reliability and possible influences of age, education and prior experience with psychotherapy on CCT in a mixed clinical sample.MethodsN = 108 patients with indication for psychotherapy were recruited. The MacCAT‐PT was administered by trained psychologists, took 20 min on average and was rated by the administering psychologist and an independent rater. Reliability statistics were investigated and regression analyses were conducted on MacCAT‐PT scores and sociodemographic variables.ResultsSufficient to moderate inter‐rater reliability (ICC = 0.80) and internal consistency (α = 0.80) were found for the total sum score of the MacCAT‐PT and its scales, Understanding (ICC = 0.79, α = 0.77), Reasoning (ICC = 0.57, α = 0.65) and Making a Choice (ICC = 0.57). Appreciation featured an unacceptable inter‐rater reliability (ICC = −0.01). Regression analyses indicated no significant effects.ConclusionThese findings suggest that the MacCAT‐PT is a reliable tool for assessing patients' overall CCT in psychotherapy. Psychometric properties of three scales were of good quality, while Appreciation needs to be reanalysed in patient samples with lower motivation for psychotherapy or limited CCT. The CCT may be suggested to be independent of age, education and prior experience. Future research should provide analyses focusing on structural and clinical validity in multiple clinical samples.

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Section: Macarthur Competence Assessment Tool For Treatment (Maccat-t)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Capacity to consent to psychotherapy: Reliability of the newly adapted German version of the MacArthur Competence Assessment Tool for Treatment for psychotherapy

Ladwig,

Pauls,

Gerke

et al. 2023

Clin Psychology and Psychoth

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“…8 Previous studies of antidepressant withdrawal have largely focused on physical withdrawal symptoms 9,10 and barriers to withdrawal. 11,12 Withdrawal effects are experienced by more than half of individuals attempting to discontinue antidepressants: some are mild and short-term while others are severe and long-lasting. 10,13 A systematic review found that 46% of individuals undergoing withdrawal from antidepressants rated their symptoms as extremely severe, with a considerable number of people experiencing these symptoms for more than two weeks, and in some cases several months.…”

Section: Introductionmentioning

confidence: 99%

“…These experiences, along with barriers to withdrawal, contribute to some patients’ reluctance to discontinue their medication. Barriers to discontinuation include fear of relapse, withdrawal symptoms, and inadequate medication management 11 . Patient interviews highlight fear as the most significant barrier, as patients worry about depressive relapse 14,20 .…”

Section: Introductionmentioning

confidence: 99%

The lived experience of withdrawal from Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants: A qualitative interview study

Mahmood,

Wallace,

Wiles

et al. 2024

Health Expectations

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BackgroundOur knowledge of the broader impacts of antidepressant withdrawal, beyond physical side effects, is limited. Further research is needed to investigate the lived experiences of withdrawal, to aid clinicians on how to guide patients through the process.AimTo explore antidepressant users’ experiences and views on the withdrawal process and how it affected their quality of life across multiple life domains.Design and SettingWe conducted in‐depth qualitative interviews with 20 individuals from the community who had attempted to withdraw from Serotonin Reuptake Inhibitor antidepressants in the past year.MethodSemi‐structured interviews were conducted online. A topic guide was used to ensure consistency across interviews. The interviews were audio‐recorded and transcribed verbatim and analysed using inductive reflexive thematic analysis.ResultsFive themes were generated. The first highlighted the challenges of managing the release from emotional blunting and cognitive suppression following antidepressant discontinuation. The second related to the negative impact of withdrawal on close relationships and social interactions. The third showed that concurrent with negative physical symptoms, there was a positive impact on health (exercise was reported by some as a coping mechanism). The fourth theme focused on support from GPs and families, emphasising the importance of mental health literacy in others. The final theme underscored the importance of gradual and flexible tapering in enabling a manageable withdrawal experience, and the consideration of timing.ConclusionThe lived experience of withdrawal significantly impacts individuals’ well‐being. Participants emphasised that withdrawal is not just about physical side effects but also affects their emotional, cognitive, and social functioning.Patient and Public Involvement (PPI)Eight people attended individual online meetings to share their experiences of antidepressant withdrawal to help inform the study design and recruitment strategy. Insights from these meetings informed the development of the topic guide. Questions about GP involvement, family relationships, and mood and thinking changes were included based on this PPI work. This ensured the inclusion of topics important to antidepressant users and facilitated the researcher's questioning during the interviews.

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“…The majority (86%) of antidepressants are prescribed in primary care [20], placing general practitioners (GPs) in a unique position to also deprescribe (the planned and supervised process of dose reduction or cessation [21]). However, antidepressant deprescribing can be complex and does not routinely occur in clinical practice [22,23] with reported barriers by both GPs and patients, including fear of relapse or recurrence and a lack of quality guidelines for deprescribing [24][25][26][27]. Discontinuation symptoms such as tremors, sweating, anxiety, mood swings, and electric shock sensations are also associated with stopping antidepressants [28][29][30] and can be confused with relapse or recurrence.…”

Section: Introductionmentioning

confidence: 99%

General Practice Patients’ Experiences and Perceptions of the WiserAD Structured Web-Based Support Tool for Antidepressant Deprescribing: Protocol for a Mixed Methods Case Study With Realist Evaluation

Coe¹,

Gunn²,

Kaylor-Hughes³

2022

JMIR Res Protoc

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Background Research suggests that the rapid increase in worldwide antidepressant use is mainly due to a rise in long-term and potentially inappropriate use. It has been suggested that 1 in 3 antidepressant users among general practice patients are no longer experiencing clinical benefits from their medication and should commence deprescribing. However there are many barriers to antidepressant deprescribing for both patients and clinicians, which adds to the complex nature of reducing or ceasing the medication. As such, antidepressant deprescribing does not routinely occur in clinical practice. Evidence-based supports and interventions for safe and successful antidepressant deprescribing are needed to assist patients and their doctors. Interventions should also include an understanding of how an intervention works, why it works, and whom it is for. Objective This study aims to evaluate how the WiserAD approach to antidepressant deprescribing works, whom it is for, and the underlying circumstances by (1) examining the experiences and perceptions of WiserAD among antidepressant users, (2) identifying the underlying mechanisms of the WiserAD approach to antidepressant deprescribing, and (3) describing in what contexts and to what extent the underlying mechanisms of WiserAD are suited for antidepressant users. Methods A mixed methods case study with realist evaluation will be conducted among participants in the WiserAD randomized controlled trial for antidepressant deprescribing. Quantitative data will be obtained from up to 12 participants from the intervention and control arms at baseline and 3-month follow-up. Baseline data will be used to characterize the sample using descriptive statistics. Paired samples t tests will also be performed to compare responses between baseline and 3-month follow-up for participant self-management, skills, confidence and knowledge, beliefs about medicines, current emotional health, and well-being symptoms. Qualitative data from the same participants will be collected via narrative interview at 3-month follow-up. Quantitative and qualitative data will be converged to form a “case,” and analysis will be conducted within each case with comparisons made across multiple cases. Results Recruitment of participants commenced in October 2022 and will be completed by March 2023. Analysis will be completed by June 2023. Conclusions To our knowledge, this will be the first realist evaluation of an antidepressant deprescribing intervention in general practice. Findings from this evaluation may assist in the implementation of the WiserAD approach to antidepressant deprescribing in routine clinical practice. International Registered Report Identifier (IRRID) PRR1-10.2196/42526

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Barriers to discontinuing antidepressants in patients with depressive and anxiety disorders: a review of the literature and clinical recommendations

Cited by 11 publications

References 58 publications

Capacity to consent to psychotherapy: Reliability of the newly adapted German version of the MacArthur Competence Assessment Tool for Treatment for psychotherapy

Capacity to consent to psychotherapy: Reliability of the newly adapted German version of the MacArthur Competence Assessment Tool for Treatment for psychotherapy

The lived experience of withdrawal from Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants: A qualitative interview study

General Practice Patients’ Experiences and Perceptions of the WiserAD Structured Web-Based Support Tool for Antidepressant Deprescribing: Protocol for a Mixed Methods Case Study With Realist Evaluation

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