Withdrawal of unnecessary antidepressant medication: A randomised controlled trial in primary care
Number of pages
SourceBJGP Open, 1, (2018), article BJGP-2017-0169
Article / Letter to editor
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Primary and Community Care
SW OZ BSI KLP
SubjectExperimental Psychopathology and Treatment; Radboudumc 0: Other Research RIHS: Radboud Institute for Health Sciences; Radboudumc 13: Stress-related disorders DCMN: Donders Center for Medical Neuroscience; Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences
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.
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