Stopping Antidepressants: The Patient Experience

1
Stopping Antidepressants The Patient Experience
Penny Louch Lead Nurse Practitioner, Swanton
Morley Nurse-led Surgery, NorfolkPhD Student,
Dept. Primary Care and Population Sciences,
University College London
Supervisors Professor Steve Iliffe (UCL),
Professor Claire Goodman (UH)
4. Results A trajectory towards
madness? Depression is an invisible illness which
makes it mysterious and less understood. Some
people fear that depression is the first step on
a trajectory towards more severe illness e.g.
schizophrenia or even madness where they would
lose all control over their lives. Depression -
A chemical imbalance? A popular concept amongst
both the interviewees and the GPs. It is a
concept which redefines depression as a physical
illness, thus making it a real illness, and
helping to alleviate fears of madness.
Redefining depression as a physical illness
legitimises the illness, because physical
illnesses have acceptable treatments. The
acceptance of a chemical imbalance model
facilitated the acceptance of the need for
antidepressants. Antidepressants friend or
foe? Antidepressants blunt your emotions and
sensitivities They make you laugh, but that
doesnt mean you are happy. Individuals have a
love-hate relationship with their
antidepressants a sign of weakness that you need
to take them and a constant reminder of the
depression but this was counterbalanced by
needing to take them in order to be able to live
life from day to day. Adjectives such as
friend, crutch, cushion, were frequently
used to describe the role of antidepressants in
peoples lives indicating the supportive and
protective elements of antidepressants in some
peoples lives. Self Hidden self You have to
hide your depression from the people around you
and can only become your real self and let the
depression out behind closed doors living with
depression means you live life like an actor
Which self is the real me? - Is it the person
who feels better with antidepressants or the
person prior to taking antidepressants, or do the
antidepressants create a new self? Changed self
Depression reflected upon as a positive
experience, an experience which changes you and
creates a new self and thus enables you to move
on to a new future. Stopping
antidepressants Antidepressants described as a
safety net, therefore to take the safety net
creates a risk, a risk of falling back down that
black hole. Again there were concerns about
finding out who was the real self when the
antidepressants were stopped will they be the
same person as they are now when they stop them
or will they revert back to that person who
needed them in the first place? Issues around
whether an individual really is better or whether
it is just the antidepressants which make them
seem better. Recovery Recovery was variably
defined for some recovery means being able to
live normally, even if that means having to take
antidepressants for ever. Alternatively for
some, recovery is a compromise, an acceptance
that life is as good as it gets. For others,
recovery means moving to a new future, becoming a
new self the depression experience was defined
as a journey, and included an acceptance that the
future might still embrace antidepressants as
part of it. For some, recovery is not a
possibility whilst continuing to need to take
antidepressants, therefore they could never be
recovered.
1. Background Much of the previous research
into antidepressant use has been quantitative
and biomedical and explores patterns of use,
efficacy and tolerability. Considerably less
research has been undertaken with the aim of
widening understanding of the patient experience
of depression and antidepressant medication
(1-4).
2. Research Questions What is the nature of
the concerns patients experience when they stop
their antidepressant medication? Are these
concerns dependent upon a personal construction
of the meaning of recovery from a depressive
illness?
3. Methods Study undertaken in single general
practice in rural mid-Norfolk with a mixed method
approach for data collection questionnaires and
interviews. QuestionnaireThe questionnaire
was based on the 8 Explanatory Model (EM)
questions which Kleinman devised to discover the
5 parts of an illness experience (5). A 2-part
short-answer questionnaire was sent to all adult
patients, aged 18-100 years who were prescribed
either a TCA
and/or an SSRI antidepressant by their GP for a
minimum
of six months and whose depression was managed

solely within primary care (572 patients).

Patients were asked to complete Part A,

personal sociodemographic

background detail necessary

to contextualise

patients EMs and

Part B
which used

Kleinmans 8 EM questions

necessary to elicit the patients

EM of their illness.
8 Explanatory Model Questions 1. What do you
call your problem? 2. What do you think has
caused your problem?3. Why do you think it
started when it did?4. What does your illness do
to you? How does it work?5. How severe is it?
Will it have a long or short course?6. What do
you fear most about your illness?7. What are the
chief problems your illness has caused you?8.
What kind of treatment do you think you should
receive? What are the most important results you
hope to receive from the treatment?
Interviews A sub-sample of 30 patients was
purposively identified
from the 201 questionnaire
respondents and were
interviewed using
Lloyd at als
Short Explanatory Model
Interview
(SEMI) framework (6).
The aim of
the interviews was
to
increase the depth and

breadth of understanding

of patients EMs and to

understand how they
anticipate
the cessation of
antidepressant

medication, what their anxieties and

concerns might be, and how this

transforms their perception of recovery

and cure.
5 Parts of an Illness Experience 1. Aetiology 2.
Time of onset 3. Pathophysiology 4. Course 5.
Treatment
Data analysis Preliminary analysis of the
questionnaire responses was undertaken using the
computer software N6 the responses were used to
identify a maximum variation sample of
prospective interview candidates for the
interview phase of the study. Interview
transcripts have been analysed using Framework -
a thematic approach to data analysis where the
data are indexed and charted according to key
issues and themes to facilitate the determination
of meaning, salience and connections.
5. Conclusion The in-depth interviews revealed
multiple insights into how individuals
contextualise depression, accept the role of
antidepressants, experience fears when planning
to stop antidepressants, anticipate and define
recovery from depression, and the impact of
depression on constructs of self. Interviewees
described the interview as cathartic an
opportunity to reflect upon and describe life
events that they had not thought about for a long
time. For some people it was the first time they
had discussed some of these issues in their
lives. The interview also provided a new clarity
about their depression, an opportunity to join up
disparate parts of their lives and create a new
personal understanding of their depression
experience.
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