Primary care healthcare professionals supporting patients to discontinue antidepressants: A scoping review of barriers, enablers and interventions

Background

Antidepressants are prescribed to treat a range of common mental disorders (CMDs) including depression and anxiety. Most people are prescribed antidepressants for longer than is necessary, leading to avoidable long-term side-effects and exacerbated withdrawal effects, if they eventually discontinue taking them. There is a need for interventions to address the barriers and enablers (determinants) of healthcare professionals (HCPs) who support people to discontinue antidepressants when they are no longer needed.

Objective

This scoping review aimed to examine the evidence base regarding the barriers and enablers to HCPs in primary care discontinuing antidepressants prescribed for mild-moderate mental health conditions, as well as interventions to facilitate HCPs to effectively support patients through the discontinuation process.

Methods

Studies were identified by undertaking a keyword search of the databases MEDLINE, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All peer-reviewed studies from inception to January 2024 were included. Two reviewers independently screened studies and extracted data. Findings were synthesised narratively.

Results

Two hundred and fifty-three studies were included in title and abstract screening and 30 studies proceeded to full-text screening. Seventeen studies were included; nine reported HCP barriers and/or enablers and eight reported interventions. Time constraints, conflicting priorities and fear of CMD relapse are commonly reported barriers whilst knowledge and skills about how to discontinue antidepressants were the main enablers. Interventions primarily involved education and training for HCPs and provision of information about how to taper antidepressants.

Discussion

Whilst existing interventions address the main enablers to HCPs discontinuing antidepressants, inclusion of components to address the barriers is a notable omission and may explain the lack of efficacy of existing interventions. Future interventions should be developed using appropriate theory and address all determinants of HCPs supporting people to discontinue antidepressants.