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

doi:10.3399/bjgpopen17X101265

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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)
Male	24 (32)	20 (29)
Marital status
Married or living together	60 (79)	56 (80)
Separated or divorced	0 (0)	2 (3)
Widow/widower	7 (9)	2 (3)
Single	9 (12)	9 (13)
Lifetime psychiatric diagnosis
Any lifetime psychiatric diagnosis	48 (63)	53 (76)
Depression	35 (46)	39 (56)
Panic disorder or agoraphobia	13 (17)	13 (19)
Generalised anxiety disorder	13 (17)	22 (31)
Social phobia	20 (26)	16 (23)
Antidepressant
Selective serotonin reuptake inhibitors	50 (66)	57 (81)
Serotonin–norepinephrine reuptake inhibitors	11 (14)	7 (10)
Other (non-tricyclic antidepressant drug)	10 (13)	2 (3)
Tricyclic antidepressant drugs	5 (7)	4 (6)
Median duration of antidepressant use at inclusion, years (range)	9.5 (1–56)	8.0 (1–48)
Comorbidity
Cardiovascular disease	7 (9)	9 (13)
Cancer	6 (8)	8 (11)
Chronic obstructive pulmonary disease/asthma	12 (16)	9 (13)
Diabetes mellitus	11 (14)	3 (4)