Zuur, J. (Joas) (2015) Meningen van huisartsen en patiënten rond langdurig antidepressivagebruik – een kwalitatief onderzoek. thesis, Medicine.
Full text available on request.Abstract
Introduction: In 2013 about 1.1 million people in the Netherlands used antidepressant drugs during a certain period of time. Approximately thirty percent of these patients used antidepressant on a long-term basis, while guidelines recommend to phase out the antidepressants between six to twelve months after remission. This implies that many patients have unnecessary side-effects and receive cost-inefficient treatment. Little is known about the opinions of patients and their General Practitioners (GPs) on this subject. This study will generate more knowledge on this subject by answering the following questions: 1. To what extent are patients using long-term antidepressive drugs and their attending GPs willing to discontinue medication? 2. What are reasons for patients and GPs to continue medication? 3. What are necessary preconditions for patients and GPs to discontinue medication? 4. What are the expectations of both patients and GPs on who is responsible for taking the initiative to talk about discontinuing antidepressants? In what extent does this influence long-term antidepressants? Method: This study was performed as a qualitative analysis of the views of 12 patients and their GPs who used antidepressant drugs for a depressive or anxiety disorder. The interviews were tape-recorded with informed consent, and transcribed verbatim. The analysis is based on grounded theory, focusing on the systematic development of theories and hypotheses through the inspection of interview responses. Emerging themes were discussed and refined using the constant comparative method. Results: The results have shown that most GPs do not have a clear defined policy in using antidepressant drugs as relapse prevention. The decision to continue using antidepressant drugs is most commonly based on the occurrence of recurrent episodes after having stopped in the past. Because of the ‘ad hoc’ policy a lot of patients escape GP’s attention and continue using antidepressant drugs. Lack of time is a common threshold for the implementation of a structural treatment policy. GPs generally take limited initiative when discussing the antidepressant use with their patients. The reason that patients stop medication is usually based on their aversion to being dependant on antidepressants Feelings of failure and fears of a stigma contribute to that aversion. However most patients do not intent to stop medication in the near future. Fear of relapse is the most common reason why patients continue medication. Furthermore patients often consider their circumstances not right to stop, or they simply have accepted their medication needs. GPs however recognize the psychological dependence that the medication induces. Patients who are intent to discontinue medication seek help. This help can be given by a GP or another aid worker. Psychological help is not often used during the stopping process. Patients assume that it is their responsibility to take initiative in discussing the topic of discontinuing medication. Discussion: In the absence of guidelines pertaining to relapse prevention GPs treat according their discretion. The level of commitment on this issue is influenced by the opinion of the GP on antidepressant use and depressive or anxiety disorders. The opinions on this matter differ between GPs. However the question should be asked whether these opinions are always correctly founded. GPs seem to find themselves capable of leading discontinuation processes. This contrasts the indicated need for more in-depth knowledge on leading different vulnerable target groups in the discontinuation of antidepressant use. Patients who want to stop long-term medication usage usually do this because they want to be independent of medication. Use of medication has a great impact on patient self-image. It is necessary that GPs are aware of this. The reason patients have to use antidepressant drugs continuously is often based on the ‘serotonin-theory’. The question is if chronic use of antidepressant based on this theory is justified. 5 Conclusion: This research offers insights on the options and ideas considering long-term antidepressant use. This also includes whether the policy concerning long-term antidepressant use should be improved in order to prevent unnecessary treatment. This research can be used as a starting point for further research on this subject.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Verhaak, Prof. Dr. P.F.M. and Huisartsgeneeskunde and UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1772 |
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