Piloting an intervention (checklist) to facilitate deprescribing antidepressants in general practice

Jochen Vukas, Oliver Senckenberg, Vita Brisnik, Tobias Dreischulte

Keywords: deprescribing, discontinuation, antidepressant, intervention, general practice, clinical guidance

Background:

The global rise in antidepressant use suggests greater acceptance but raises concerns about overprescription. Long-term and unnecessary prescriptions, especially for mild to moderate depression or sleep disturbances, drive this trend. Antidepressant use comes with risks of numerous adverse drug reactions (ADRs), particularly in vulnerable older adults. In this regard, the concept of deprescribing experiences increasing awareness. However, there is a need to further investigate for targeted interventions to facilitate deprescribing in general practice.

Research questions:

Developing and testing a deprescribing intervention to support general practitioners in appropriately deprescribing antidepressants.

Method:

We followed the 2021 version of the Medical-Research-Council-Framework for the development and evaluation of complex interventions. First, we conducted qualitative semi-structured interviews with general practitioners based on the Capability-Opportunity-Motivation-Behaviour Framework to explore for factors influencing deprescribing behaviour. Second, we conducted a systematic review of clinical practice guidelines and extracted recommendations regarding appropriate treatment durations and strategies to avoid antidepressant ADRs. Third, we developed an intervention based on the Behaviour-Change-Wheel-Framework using results generated by the interviews and the systematic review. We started a pilot study.

Results:

For the interview study, we recruited 20 general practitioners. Facilitators were: self-confidence and professional experience. Identified barriers were: lack of interdisciplinary collaboration, uncertainties in decision-making and inadequate or missing tools to support decision-making. To further improve medication-safety and antidepressant deprescribing, participants suggested: shared-decision-making, good relationships with patients, practical tools as decision-aids and comprehensive practice-management-software.
The literature search of 14 guidelines revealed a lack of recommendations on when discontinuation of antidepressants may be attempted. We noted inconsistencies in the statements regarding adverse effects, high-risk prescriptions, and overprescribing and found points of departure for deprescribing based on the warnings and recommendations.

Conclusions:

A study protocol for a pilot study to evaluate the feasibility, acceptability, and effectivity of the intervention was created. The pilot study is ongoing. Results will be expected by October.

Points for discussion:

Deprescribing intervention (checklist): feasible, accepted, effective?

Improvements/adaptions for a randomized controlled study?

#59