Rhona Eveleigh1, Esther Muskens2, Peter Lucassen3, Peter Verhaak4,5, Jan Spijker6,7, Chris van Weel8,9, Richard Oude Voshaar10,11, Anne Speckens10. 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.
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.
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.
Entities:
Keywords:
antidepressant agents; anxiety disorder; depressive disorder; general practice; inappropriate prescribing; primary care
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