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

Abstract

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

Understanding Australian general practice patients’ decisions to deprescribe antidepressants in the WiserAD trial: a realist informed approach

“…Anticipated outcomes (O) ranged from no intent to deprescribe to successful completion of deprescribing. Detailed methods for the formulation of the initial programme theory tested in the current study are detailed elsewhere and depicted in figure 1 24…”

“…The WiserAD randomised control trial (RCT) (herein referred to as WiserAD or the WiserAD trial and described elsewhere 24 ) aims to test a patient-facing, web-based structured support tool for patients and GPs to taper antidepressants while maintaining stable mental health and well-being. Participants aged 18–75 years and taking a selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor from participating general practices are invited into the trial by the WiserAD team and their GP.…”

“…As per realist evaluation, an initial theory of how WiserAD might work to trigger an outcome was also formulated (see Coe et al 24 ). The specific resource mechanisms tested in this study were (1) initiation of and participating in shared decision-making with GP regarding antidepressant deprescribing; (2) provision of patient education; (3) tapering guidance; (4) availability of relational support and (5) technical support from the WiserAD portal.…”

“…Detailed methods for the formulation of the initial programme theory tested in the current study are detailed elsewhere and depicted in figure 1 . 24 …”

Social media group support for antidepressant deprescribing: a mixed-methods survey of patient experiences

“…Further, a recent review suggests that there is inadequate guidance for clinicians and patients when distinguishing withdrawal from relapse and managing withdrawal symptoms (Sørensen et al 2022). Evidence-based information and research into antidepressant deprescribing is currently in its infancy (Gupta et al 2019), with two trials underway in Australia (Coe et al 2022;Kaylor-Hughes et al 2023;Wallis et al 2023a), one in the UK (Kendrick et al 2020) and one in the Netherlands (Bot 2024). As such, a lack of information and support has led to patients recommencing antidepressant treatment or seeking other avenues for help (White et al 2021;Read et al 2023).…”