The missing link? Pharmacists' perspectives on discontinuation of long-term antidepressants: a qualitative study

Abstract

Background: Long-term use of antidepressant drugs is widespread despite guidelines recommending limited duration. General practitioners (GPs) play a central role in reviewing and discontinuing antidepressants, although they hesitate to initiate a discussion about the long-term use. The potential role of pharmacists in this process is underexplored, despite their pharmaceutical expertise and accessibility.

Objectives: To explore community pharmacists' perspectives on the discontinuation of long-term use of antidepressants, and the barriers and facilitators to their involvement in this process.

Design: Qualitative study.

Methods: Semi-structured interviews were conducted with 14 Belgian community pharmacists until data saturation. Interviews were recorded, transcribed, and thematically analyzed.

Results: Four themes emerged. (1) "Antidepressants at the pharmacy: a persistent taboo" showed pharmacists' hesitancy to initiate discontinuation discussions due to societal stigma and fear of being perceived as nosy. (2) "Balancing risks vs benefits" highlights that pharmacists were primarily concerned about relapse in stable patients but recognized that a patient request from a patient experiencing side effects may facilitate discontinuation. (3) "Is this my role?," pharmacists viewed GPs as the primary decision-makers in discontinuation, limiting their role to supporting GP treatment decisions. Key facilitators for discontinuation included a GP's decision to stop and a motivated patient. Regular reviews by the pharmacist could also facilitate the discontinuation process. (4) Optimizing pharmacists' role' with a strong need for GP collaboration, and acknowledging a need to optimize knowledge and skills to support antidepressant discontinuation.

Conclusion: Our study reveals that pharmacists viewed GPs as pivotal in the discontinuation process, as they make the decisions, while they see their role as supportive, following the doctor's decision. However, they faced significant barriers to discontinuing long-term antidepressants, including fear of relapse, societal taboo, and unclear responsibilities. More education, confidence building, and better collaboration with GPs could empower pharmacists to play a proactive role, improving the antidepressant discontinuation process.

Keywords: antidepressants; depressive disorder; discontinuation; pharmacists; primary care.