Discontinuing antidepressant medication: a qualitative evidence synthesis and logic model based on health...

Increased long-term antidepressant medication (ADM) use can lead to serious psychological and physical public health implications, as well as increased financial costs and social injustice. Given that health professionals (HPs) can influence decisions on ADM discontinuation, it is imperative that to promote and enable discontinuation when the medication is no longer indicated, their perspectives around this issue are explored in depth. This systematic review of qualitative evidence aimed to identify HPs' perspectives on the barriers and facilitators to ADM discontinuation / deprescribing.

Eligible studies were primary studies, on HPs' views on ADM discontinuation / deprescribing, that used qualitative data collection and analysis, and were published in English. We searched PubMed, CINAHL, PsycINFO, the British Journal of General Practice, the Networked Digital Library of Theses and Dissertations, and Google Scholar, from July 2018 until May 2022, and harvested studies from a review published in 2019. The PubMed search was repeated post-synthesis, in January 2024, to identify and incorporate studies published since May 2022. Data was synthesised using thematic synthesis and further analysed using Bronfenbrenner's Social Ecological Model (SEM) and a logic model. One reviewer extracted data and assessed study quality, which was checked by a second reviewer. Coding and development of themes and sub-themes was undertaken by one reviewer and further developed through discussion with a second reviewer.

Fourteen studies were included capturing the views of over 280 HPs. The synthesis yielded eight analytical themes: Perceptions of ADM; Perceptions of Depression; Sense of Professional Duty; Confidence in Supporting ADM Discontinuation; Assessment of Patients' Circumstances and Characteristics; Assessment of Patients' Desires, Motivations and Capabilities; Systemic Healthcare Delivery Issues; and, Societal Norms and Pressures.

Use of the SEM and development of a logic model uncovered possible pathways and underlying reasons through which factors influencing ADM discontinuation interrelate both within and across societal levels. Societal norms and pressures, and systemic healthcare delivery issues, appear to influence directly or indirectly all aspects around ADM discontinuation / deprescribing. Future research and interventions could target barriers highlighted by these two themes demonstrating the largest impact.