Antidepressant medication prescribing has increased steadily over the past three decades and now more than 60 million prescriptions for the drugs are issued each year in England, to more than 10% of the adult population.

REviewing long term anti-Depressant Use by Careful monitoring in Everyday practice (REDUCE study)

Our previous research showed this is not due to a significant increase in depression, but more to GPs prescribing longer courses of antidepressants – the average length of treatment is now more than two years.

Some people need to take antidepressants long-term to prevent relapse of their depression, but most need them only for 9-12 months in the first instance, according to the NICE national guidelines. When surveys have been carried out of people taking antidepressants long-term they have found that between a third and a half have no evidence-based indication for continuing use.

However stopping antidepressants is often not easy, due to withdrawal symptoms including anxiety and mood changes which feel similar to the reason why treatment was started in the first place. When patients stop their medication they often experience withdrawal symptoms, which makes some think their original depression or anxiety is returning, and so they restart the drugs rather than giving the withdrawal symptoms time to settle.

Patients on long-term treatment are often given repeat prescriptions and reviewed only once or twice a year by their GPs. Prompting GPs or nurse practitioners (NPs) to review patients can help some start to come off treatment, but with the current pressure on general practice appointments, continuing help is needed for patients, including outside surgery hours.

The REDUCE research programme is a £2.4 million six year study funded by an NIHR Programme Grant for Applied Research and led by Tony Kendrick aims to tackle the rising tide of unnecessary long-term antidepressant prescribing.

An internet-supported package with advice for patients on dealing with withdrawal symptoms and when to seek help will be developed and delivered using LifeGuide software developed in Southampton.

The plan includes a systematic literature review to identify interventions known to facilitate antidepressant withdrawal. Planning the Internet intervention will draw on this literature, and be informed by social learning theory and behaviour change models, our team’s expertise, and insights gained from patient and public involvement in our study team.

Both practitioners and patients will be involved in qualitative and think-aloud interviews which are part of the ‘person based approach’ (PBA) developed by Professor Lucy Yardley’s group in Southampton which aims at understanding and addressing the user perspective, crucial to developing feasible, acceptable, and motivating interventions. The intervention will be subject to feasibility work followed by a full trial.

The aim is to develop a usable framework with an internet-supported intervention to support antidepressant withdrawal which will be promoted through patient groups. The benefits to patients and the NHS will include reductions in inappropriate treatment of patients, the costs of drugs, and the cost of long-term monitoring. Most importantly, patients will be helped to come off unnecessary treatment, avoid the risk of side-effects long-term, and feel more self-reliant and confident they can manage without taking something for the rest of their lives.

This work is part of the PCPS strategy to support patient self help with chronic diseases and to use behaviour change interventions.

Reviewing long term anti-depressant use

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