• Carina Meißner, Ann-Katrin Meyrose, and Yvonne Nestoriuc.
• Helmut-Schmidt-University / University of the Armed Forces Hamburg, Clinical Psychology and Psychotherapy, Hamburg, Germany c.meissner@hsu-hh.de.
• Br J Gen Pract. 2024 Jan 16.

BackgroundMany patients with depressive disorders use antidepressants longer than clinically indicated. Long-term use is associated with high individual and societal costs. Patients often perceive antidepressant discontinuation as challenging.AimTo understand patients' expectations towards discontinuation, document their experiences with long-term use and discontinuation, and identify factors that can help or hinder discontinuation.Design And SettingQualitative study using semi-structured interviews via telephone with adult patients in Germany.MethodThirty-two patients with remitted Major Depressive Disorder and long-term antidepressant use were interviewed. We analysed transcripts with content analysis aided by MaxQDA to derive thematic categories.ResultsPatients expected to eliminate side effects or regain independence following discontinuation. Such positive expectations were perceived as facilitators and motivated patients' discontinuation wish. However, patients also had negative expectations such as recurrence or discontinuation symptoms. Patients' negative expectations were often fuelled by negative experiences, persisted despite a wish to stop antidepressants, and hindered discontinuation. Most patients perceived antidepressants as effective, but experienced side effects and further hassles. Patients felt inadequately informed about treatment duration and methods for discontinuation. Further barriers and facilitators included a stable environment, availability of support, and treatment information.ConclusionPatients prefer to discontinue antidepressants within structured frameworks that provide information and support. Identified facilitators and barriers may help optimise appropriate use and discontinuation of antidepressants in routine practice. The utility of functional expectations and specification of individualised approaches to minimise dysfunctional expectations, adapted to patients' previous experiences, appear to be especially important.Copyright © 2024, The Authors.

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