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Br J Gen Pract. Apr 1, 2010; 60(573): e144–e155.
PMCID: PMC2845505
Long-term prescribing of antidepressants in the older population: a qualitative study
Rebecca Dickinson, MSc, Research Nurse and Peter Knapp, RGN, PhD, Senior Lecturer
School of Healthcare, University of Leeds, Leeds
Allan O House, DM, MRCP, MRCPsych, Professor of Liaison Psychiatry
Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds
Vandana Dimri, MSc, PhD, MRCPsych, Specialty Trainee in Psychiatry
Institute of Health Sciences, University of Leeds, Leeds
Arnold Zermansky, FRCGP, Honorary Senior Research Fellow and Duncan Petty, PhD, MRPharmS, Lecturer
School of Healthcare, University of Leeds, Leeds
John Holmes, MD, MRCPsych, Senior Lecturer in Liaison Psychiatry of Old Age
Institute of Health Sciences, University of Leeds, Leeds
David K Raynor, PhD, MRPharmS, Professor of Pharmacy Practice
School of Healthcare, University of Leeds, Leeds
Address for correspondence Professor David K Raynor, University of Leeds, School of Healthcare, Baines Wing, Academic Unit of Medicines Management, Leeds, LS29UT. E-mail: D.K.Raynor/at/leeds.ac.uk
Received August 13, 2009; Revised October 19, 2009; Accepted February 24, 2010.
Abstract
Background
High rates of long-term antidepressant prescribing have been identified in the older population.
Aims
To explore the attitudes of older patients and their GPs to taking long-term antidepressant therapy, and their accounts of the influences on long-term antidepressant use.
Design of study
Qualitative study using in-depth semi-structured interviews.
Setting
One primary care trust in North Bradford.
Method
Thirty-six patients aged ≥75 years and 10 GPs were interviewed. Patients were sampled to ensure diversity in age, sex, antidepressant type, and home circumstances.
Results
Participants perceived significant benefits and expressed little apprehension about taking long-term antidepressants, despite being aware of the psychological and social factors involved in onset and persistence of depression. Barriers to discontinuation were identified following four themes: pessimism about the course and curability of depression; negative expectations and experiences of ageing; medicine discontinuation perceived by patients as a threat to stability; and passive (therapeutic momentum) and active (therapeutic maintenance) decisions to accept the continuing need for medication.
Conclusion
There is concern at a public health level about high rates of long-term antidepressant prescribing, but no evidence was found of a drive for change either from the patients or the doctors interviewed. Any apprehension was more than balanced by attitudes and behaviours supporting continuation. These findings will need to be incorporated into the planning of interventions aimed at reducing long-term antidepressant prescribing in older people.
Keywords: antidepressants, prescribing, attitudes
Articles from The British Journal of General Practice are provided here courtesy of
Royal College of General Practitioners