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Research

Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care

Rhona Eveleigh, Esther Muskens, Peter Lucassen, Peter Verhaak, Jan Spijker, Chris van Weel, Richard Oude Voshaar and Anne Speckens
BJGP Open 2018; 1 (4): bjgpopen17X101265. DOI: https://doi.org/10.3399/bjgpopen17X101265
Rhona Eveleigh
Nursing Home Physician, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen , The Netherlands
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Esther Muskens
Psychologist, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen , The Netherlands
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Peter Lucassen
GP, Senior Researcher, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen , The Netherlands
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  • For correspondence: Peter.Lucassen@radboudumc.nl
Peter Verhaak
Professor of Primary Care, Department of Primary Care, University Groningen, University Medical Center Groningen, Nijmegen , The Netherlands Professor of Primary Care, Department of Mental Health, Netherlands Institute for Health Service Research (NIVEL), Utrecht , The Netherlands
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Jan Spijker
Professor of Psychiatry, Center of Depression Expertise, Pro Persona, Nijmegen , The Netherlands Professor of Psychiatry, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen , The Netherlands
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Chris van Weel
Emeritus Professor of Primary Care, Department Health Services Research and Policy, Australian National University, Canberra , Australia Emeritus Professor of Primary Care, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen , The Netherlands
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Richard Oude Voshaar
Professor of Psychiatry, Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen , The Netherlands Professor of Psychiatry, University Medical Center Groningen, University Center for Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), University of Groningen, Groningen , The Netherlands
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Anne Speckens
Professor of Psychiatry, Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen , The Netherlands
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    Figure 1. Flow diagram of practices and participants.aPost-randomisation patients did not meet inclusion criteria (human error during inclusion process). bPatients who did not complete follow-up interview. cPatients excluded with unknown primary outcome (due to dual primary outcome, excluded cases are less than patients lost to follow-up; that is, antidepressant use known via GP prescription database). dIntervention group restricted to patients with the intention to comply to recommendation and patients excluded with unknown primary outcome.
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    Figure 2. Patient flow and outcome in the overtreatment trial. In the intervention group 20/70 patients were lost to follow-up (12 in the group of patients with no intention to comply and 8 in the group with the intention to comply with the recommendation). In the control group 10/76 patients were lost to follow-up. AD = antidepressant.

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    Table 1. Baseline characteristics of participants (inappropriate long-term antidepressant users) in the overtreatment trial at individual level in frequencies, unless stated otherwise. Overtreatment: ≥9 months antidepressant use, without a current indication for maintenance therapy
    Overtreatment trial, n (%)
    Control (n = 76)Intervention (n = 70)
    Mean age, years (SD) 56 (14.3)56 (12.9)
    Male24 (32)20 (29)
    Marital status
    Married or living together60 (79)56 (80)
    Separated or divorced0 (0)2 (3)
    Widow/widower7 (9)2 (3)
    Single9 (12)9 (13)
    Lifetime psychiatric diagnosis
    Any lifetime psychiatric diagnosis48 (63)53 (76)
    Depression35 (46)39 (56)
    Panic disorder or agoraphobia13 (17)13 (19)
    Generalised anxiety disorder13 (17)22 (31)
    Social phobia20 (26)16 (23)
    Antidepressant
    Selective serotonin reuptake inhibitors50 (66)57 (81)
    Serotonin–norepinephrine reuptake inhibitors11 (14) 7 (10)
    Other (non-tricyclic antidepressant drug)10 (13)2 (3)
    Tricyclic antidepressant drugs5 (7)4 (6)
    Median duration of antidepressant use at inclusion, years (range)9.5 (1–56)8.0 (1–48)
    Comorbidity
    Cardiovascular disease7 (9)9 (13)
    Cancer6 (8)8 (11)
    Chronic obstructive pulmonary disease/asthma12 (16)9 (13)
    Diabetes mellitus11 (14) 3 (4)
    • SD = standard deviation.

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BJGP Open
Vol. 1, Issue 4
January 2018
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Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care
Rhona Eveleigh, Esther Muskens, Peter Lucassen, Peter Verhaak, Jan Spijker, Chris van Weel, Richard Oude Voshaar, Anne Speckens
BJGP Open 2018; 1 (4): bjgpopen17X101265. DOI: 10.3399/bjgpopen17X101265

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Withdrawal of unnecessary antidepressant medication: a randomised controlled trial in primary care
Rhona Eveleigh, Esther Muskens, Peter Lucassen, Peter Verhaak, Jan Spijker, Chris van Weel, Richard Oude Voshaar, Anne Speckens
BJGP Open 2018; 1 (4): bjgpopen17X101265. DOI: 10.3399/bjgpopen17X101265
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Keywords

  • antidepressant agents
  • Primary care
  • depressive disorder
  • anxiety disorder
  • general practice
  • inappropriate prescribing

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  • Experience of primary care for people with HIV: a mixed-method analysis
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