Why do patients discontinue antidepressant therapy early? A qualitative study

Jaffray, Mariesha; Cardy, Amanda Hamilton; Reid, Ian; Cameron, Isobel M.

doi:10.3109/13814788.2013.838670

Cited by 24 publications

(21 citation statements)

References 20 publications

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“…It seems that the discontinuation could be due to rational patient behaviour balancing improved asthma control against adverse effects, price and convenience. This is in line with the finding of qualitative studies on other treatments, where ownership, knowledge and support were important factors for patient adherence .…”

Section: Discussionsupporting

confidence: 89%

Early Discontinuation of Montelukast Treatment; A Danish Nationwide Utilization Study

Farah

Damkier

Christiansen

et al. 2018

Basic Clin Pharma Tox

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Montelukast, a leukotriene receptor antagonist, was marketed in 1998 as an oral supplementary treatment to patients with mild to moderate asthma. The aim of this study was to describe the early discontinuation pattern among montelukast users in Denmark in the period of 1 March 1998 to 31 December 2016, and to identify demographic characteristics possibly associated with early discontinuation. This nationwide drug utilization study was based on data collected from three nationwide Danish registers. All montelukast users who redeemed at least one prescription in the study period were identified. Early discontinuation was defined as failing to fill a second prescription for montelukast within at least a year after the initial montelukast prescription. Among 135,271 included montelukast users, 47,480 (35%) discontinued the use of montelukast after a single redeemed prescription. The trend in early discontinuation increased throughout the years. The most predominant demographic risk factors for early discontinuation were prescription for only nasal topical anti-allergic treatment up to a year prior to montelukast initiation [adjusted odds ratio (OR) 2.25; 95% confidence interval (CI) 2.13-2.38], as well as suspected off-label use (adjusted OR 2.02; 95% CI 1.97-2.08). Several risk factors were associated with a decreased risk of early discontinuation; most pronounced was a prescription of inhaled corticosteroids within a year up to montelukast initiation [adjusted OR 0.47 (95% CI 0.46-0.49)]. Early discontinuation was more pronounced after patent expiry in 2012 [adjusted OR 1.42 (95% CI 1.38-1.45)]. In conclusion, we found that early montelukast discontinuation increased during the last 19 years. Appropriateness of the treatment indication as estimated by concomitant prescription of adequate inhalation therapy was associated with a low risk of early discontinuation. A more pronounced early discontinuation was observed after patent expiry in 2012, which could reflect a more liberal approach to montelukast prescription.

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Section: Discussionsupporting

confidence: 89%

Early Discontinuation of Montelukast Treatment; A Danish Nationwide Utilization Study

Farah

Damkier

Christiansen

et al. 2018

Basic Clin Pharma Tox

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“…Together these identify a new potential factor which may influence early antidepressant discontinuation, possibly linking with perceived inertia and service dissatisfaction as previously identified [48, 49]. Prescribers also demonstrated that antidepressants were only one of many treatment modalities, and that the GPs themselves had a therapeutic function as listener, counsellor and facilitator [49–51], as well as creating space through use of sickness certificates [52].…”

Section: Discussionmentioning

confidence: 88%

‘Doing the right thing’: factors influencing GP prescribing of antidepressants and prescribed doses

et al. 2017

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BackgroundAntidepressant prescribing continues to increase, with 5-16% of adults receiving antidepressants annually. Total prescribing growth is due in part to increased long-term use, greater selective serotonin re-uptake inhibitor (SSRI) use and the use of higher SSRI doses. Evidence does not support routine use of higher SSRI doses for depression treatment, and factors influencing the use of such doses are not well known. The aim of this study was to explore factors influencing GPs’ use of antidepressants and their doses to treat depression.MethodsSemi-structured interviews with a purposive sample of 28 practising GPs; sampled by antidepressant prescribing volume, practice size and deprivation level. A topic guide drawing on past literature was used with enough flexibility to allow additional themes to emerge. Interviews were audio-recorded and transcribed verbatim. Framework analysis was employed. Constant comparison and disconfirmation were carried out across transcripts, with data collection being interspersed with analysis by three researchers. The thematic framework was then systematically applied to the data and conceptualised into an overarching explanatory model.ResultsDepression treatment involved ethical and professional imperatives of ‘doing the right thing’ for individuals by striving to achieve the ‘right care fit’. This involved medicalised and non-medicalised patient-centred approaches. Factors influencing antidepressant prescribing and doses varied over time from first presentation, to antidepressant initiation and longer-term treatment. When faced with distressed patients showing symptoms of moderate to severe depression GPs were confident prescribing SSRIs which they considered as safe and effective medicines, and ethically and professionally appropriate.Many GPs were unaware that higher doses lacked greater efficacy and onset of action occurred within 1-2 weeks, preferring to wait 8-12 weeks before increasing or switching. Ongoing pressures to maintain prescribing (e.g. fear of depression recurrence), few perceived continuation problems (e.g. lack of safety concerns) and lack of proactive medication review (e.g. patients only present in crisis), all combine to further drive antidepressant prescribing growth over time.ConclusionsGPs strive to ‘do the right thing’ to help people. Antidepressants are only a single facet of depression treatment. However, increased awareness of drug limitations and regular proactive reviews may help optimise care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0643-z) contains supplementary material, which is available to authorized users.

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“…Across the literature, stigma emerged as a concept of central importance to women engaged in treatment DM related to antidepressant use during pregnancy. The stigma of depression (Cooper-Patrick et al, 1997;Fosgerau & Davidsen, 2014;Garfield et al, 2004;Jaffray, Cardy, Reid, & Cameron, 2014;Kwintner, 2005;Malpass et al, 2009;Maxwell, 2005;Simon et al, 2007;Stecker & Alvidrez, 2007;van Geffen et al, 2011;Verbeek-Heida & Mathot, 2006) and the fear of dependency on antidepressants (Garfield et al, 2004;Jaffray et al, 2014;Johnston, 2013;Kwintner, 2005;Malpass et al, 2009;Maxwell, 2005;Simon et al, 2007;van Geffen et al, 2011;Verbeek-Heida & Mathot, 2006) are two of the most frequently identified barriers in the broader depression treatment DM literature. In the context of pregnancy, women have a heightened awareness of social norms and feel intense pressure to conform, even outside the context of depression (Baggley, Navioz, Maltepe, Koren, & Einarson, 2004;Lupton, 2011;Noseworthy et al, 2013;Santalahti, Hemminki, Latikka, & Ryynänen, 1998;Wittmann-Price & Bhattacharya, 2008…”

Section: Discussionmentioning

confidence: 99%

Women's decision making about antidepressant use during pregnancy: A narrative review

Hippman

Balneaves

2018

Depress Anxiety

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Why do patients discontinue antidepressant therapy early? A qualitative study

Abstract: Health care professionals would benefit from exploring patient knowledge and views on depression and antidepressants at an early stage in treatment. Patients would welcome active involvement in treatment decision making, the provision of information and ongoing support.

Cited by 24 publications

References 20 publications

Early Discontinuation of Montelukast Treatment; A Danish Nationwide Utilization Study

Early Discontinuation of Montelukast Treatment; A Danish Nationwide Utilization Study

‘Doing the right thing’: factors influencing GP prescribing of antidepressants and prescribed doses

Women's decision making about antidepressant use during pregnancy: A narrative review

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