3.1.3 Depression: The patient experience of stopping antidepressants (13)

Penny Louch, Lead Nurse Practitioner / PhD Student, Primary Care and Population Sciences, University College London, United Kingdom Co authors: Claire Goodman & Steve Iliffe

Abstract:

Aim:

This paper presents findings from a primary care based, mixed method study that aims to explore patients’ fears and concerns when anticipating stopping their antidepressant medication.

Methods:

The study has two phases, a survey of a general practice population and in-depth interviews with a sub-sample of the original survey respondents. Drawing on the work of Kleinman (1980) and his theory of explanatory models of illness, a questionnaire was sent to 572 patients who were receiving either a tricyclic antidepressant or an SSRI antidepressant from one General Practice. A sub-sample of 30 patients was purposively identified from the 201 questionnaire respondents and interviewed using Lloyd at al’s (1998) Short Explanatory Model Interview framework. The aim of the interviews was to increase the depth and breadth of understanding of patients’ explanatory models in order to understand how they anticipate the cessation of antidepressant medication, what their anxieties and concerns might be, and how this transforms their perception of recovery and cure.

Results:

The 30 interview transcripts were analysed using Framework (Ritchie & Spencer 1994), a systematic approach to data analysis which is transparent and reproducible.

Themes identified from the interviews include:

  • Is depression the first step on a trajectory towards madness?
  • Depression as a chemical imbalance: depression redefined as a physical illness
  • Are antidepressants friend or foe?
  • The nature of self
  • Fears and concerns about stopping antidepressants
  • Recovery and the role of antidepressants

Conclusion:

The use of a questionnaire that draws on lay models of illness belief informed the identification of a sub-sample of 30 patients in a primary care setting. The in-depth interviews revealed multiple insights into how individuals contextualise depression, experience fears when planning to stop antidepressants, anticipate and define recovery from depression, and the impact of depression on constructs of self.

Recommended reading list:

  • Kleinman, A. 1980, Patients and healers in the context of culture University of California Press, Berkeley, CA
  • Lloyd, K. R., Jacob, K. S., Patel, V., St Louis, L., Bhugra, D., & Mann, A. H. 1998, "The development of the Short Explanatory Model Interview (SEMIS) and its use among primary care attenders with common mental disorders", Psychological Medicine, vol. 28, no. 5, pp. 1231-1237
  • Ritchie, J. & Spencer, L. 1994, "Qualitative data analysis for applied policy research," in Analysing Qualitative Data, A. Bryman & R. G. Burgess, eds., Routledge, London, pp. 173-194

Source of Funding: UK - Research Charity/Foundation

Level of funding: 50,001 - 100,000

Biography:

I am the Lead Nurse Practitioner for Health E1 Medical Practice, a Tower Hamlets nurse-led practice which provides medical services to the homeless population of London E1. I am studying for a PhD Primary Care at University College London and am exploring the patients’ experiences, concerns and fears about stopping antidepressant medication when they are well. I am a Leading Practice Through Research Award Holder from the Health Foundation.