Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care

Rhona Eveleigh¹, Esther Muskens², Peter Lucassen³, Peter Verhaak^{4

5}, Jan Spijker^{6

7}, Chris van Weel^{8

9}, Richard Oude Voshaar^{10

11}, Anne Speckens¹⁰

Affiliations

¹ Nursing Home Physician, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
² Psychologist, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
³ GP, Senior Researcher, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴ Professor of Primary Care, Department of Primary Care, University Groningen, University Medical Center Groningen, Nijmegen, The Netherlands.
⁵ Professor of Primary Care, Department of Mental Health, Netherlands Institute for Health Service Research (NIVEL), Utrecht, The Netherlands.
⁶ Professor of Psychiatry, Center of Depression Expertise, Pro Persona, Nijmegen, The Netherlands.
⁷ Professor of Psychiatry, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
⁸ Emeritus Professor of Primary Care, Department Health Services Research and Policy, Australian National University, Canberra, Australia.
⁹ Emeritus Professor of Primary Care, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁰ Professor of Psychiatry, Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
¹¹ Professor of Psychiatry, University Medical Center Groningen, University Center for Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands.

PMID: 30564695
PMCID: PMC6181099
DOI: 10.3399/bjgpopen17X101265

Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care

Rhona Eveleigh et al. BJGP Open. 2017.

. 2017 Nov 15;1(4):bjgpopen17X101265.

doi: 10.3399/bjgpopen17X101265. eCollection 2018 Jan.

Authors

Rhona Eveleigh¹, Esther Muskens², Peter Lucassen³, Peter Verhaak^{4

5}, Jan Spijker^{6

7}, Chris van Weel^{8

9}, Richard Oude Voshaar^{10

11}, Anne Speckens¹⁰

Affiliations

¹ Nursing Home Physician, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
² Psychologist, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
³ GP, Senior Researcher, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴ Professor of Primary Care, Department of Primary Care, University Groningen, University Medical Center Groningen, Nijmegen, The Netherlands.
⁵ Professor of Primary Care, Department of Mental Health, Netherlands Institute for Health Service Research (NIVEL), Utrecht, The Netherlands.
⁶ Professor of Psychiatry, Center of Depression Expertise, Pro Persona, Nijmegen, The Netherlands.
⁷ Professor of Psychiatry, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
⁸ Emeritus Professor of Primary Care, Department Health Services Research and Policy, Australian National University, Canberra, Australia.
⁹ Emeritus Professor of Primary Care, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁰ Professor of Psychiatry, Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
¹¹ Professor of Psychiatry, University Medical Center Groningen, University Center for Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands.

PMID: 30564695
PMCID: PMC6181099
DOI: 10.3399/bjgpopen17X101265

Abstract

Background: Antidepressant use has increased exponentially in recent decades, mostly due to long continuation.

Aim: To assess the effectiveness of a tailored recommendation to withdraw antidepressant treatment.

Design & setting: Randomised controlled trial in primary care (PANDA study) in the Netherlands.

Method: Long-term antidepressant users (≥9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview (CIDI). Long-term users without indication for maintenance treatment (overtreatment) were selected. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. Patients were followed for 12 months.

Results: The study included 146 participants from 45 family practices. Of the 70 patients in the intervention group, 34 (49%) did not comply with the advice to stop their antidepressant medication. Of the 36 (51%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. Patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (26% versus 13%, P = 0.05).

Conclusion: Changing inappropriate long-term antidepressant use is difficult.

Keywords: antidepressant agents; anxiety disorder; depressive disorder; general practice; inappropriate prescribing; primary care.

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Conflict of interest statement

The authors declare that no competing interests exist.

Figures

Figure 1.. Flow diagram of practices and participants.^aPost-randomisation patients did not meet inclusion criteria (human error during inclusion process). ^bPatients who did not complete follow-up interview. ^cPatients excluded with unknown primary outcome (due to dual primary outcome, excluded cases are less than patients lost to follow-up; that is, antidepressant use known via GP prescription database). ^dIntervention group restricted to patients with the intention to comply to recommendation and patients excluded with unknown primary outcome.

Figure 2.. Patient flow and outcome in the overtreatment trial. In the intervention group 20/70 patients were lost to follow-up (12 in the group of patients with no intention to comply and 8 in the group with the intention to comply with the recommendation). In the control group 10/76 patients were lost to follow-up. AD = antidepressant.

See this image and copyright information in PMC

References

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Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care

Affiliations

Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources