No CrossRef data available.
Article contents
Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys
Published online by Cambridge University Press: 14 September 2023
Abstract
Background
Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation.
Methods
Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months.
Results
10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation.
Conclusion
Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.
- Type
- Invited Review
- Information
- Copyright
- Copyright © The Author(s), 2023. Published by Cambridge University Press
References
Akincigil, A., Bowblis, J. R., Levin, C., Walkup, J. T., Jan, S., & Crystal, S. (2007). Adherence to antidepressant treatment among privately insured patients diagnosed with depression. Medical Care, 45(4), 363–369. doi: 10.1097/01.mlr.0000254574.23418.f6CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder. Retrieved from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdfGoogle Scholar
Anderson, K. N., Bautista, C. L., & Hope, D. A. (2019). Therapeutic alliance, cultural competence and minority status in premature termination of psychotherapy. The American Journal of Orthopsychiatry, 89(1), 104–114. doi: 10.1037/ort0000342CrossRefGoogle ScholarPubMed
Bai, Y., Yang, H., Chen, G., & Gao, K. (2020). Acceptability of acute and maintenance pharmacotherapy of bipolar disorder: A systematic review of randomized, double-blind, placebo-controlled clinical trials. Journal of Clinical Psychopharmacology, 40(2), 167–179. doi: 10.1097/jcp.0000000000001169CrossRefGoogle ScholarPubMed
Bambauer, K. Z., Soumerai, S. B., Adams, A. S., Zhang, F., & Ross-Degnan, D. (2007). Provider and patient characteristics associated with antidepressant nonadherence: The impact of provider specialty. The Journal of Clinical Psychiatry, 68(6), 867–873. doi: 10.4088/jcp.v68n0607CrossRefGoogle ScholarPubMed
Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., … Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis. Focus (American Psychiatric Publishing), 14(2), 229–243. doi: 10.1176/appi.focus.140201Google ScholarPubMed
Boudreau, D. M., Daling, J. R., Malone, K. E., Gardner, J. S., Blough, D. K., & Heckbert, S. R. (2004). A validation study of patient interview data and pharmacy records for antihypertensive, statin, and antidepressant medication use among older women. American Journal of Epidemiology, 159(3), 308–317. doi: 10.1093/aje/kwh038CrossRefGoogle ScholarPubMed
Brody, D. J., & Gu, Q. (2020). Antidepressant use among adults: United States, 2015–2018. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db377.htmGoogle Scholar
Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: A global return on investment analysis. The Lancet Psychiatry, 3(5), 415–424. doi: 10.1016/s2215-0366(16)30024-4CrossRefGoogle ScholarPubMed
Chiu, M., Lebebaum, M., Cheng, J., de Oliveira, C., & Kurdyak, P. (2017). The direct healthcare costs associated with psychological distress and major depression: A population-based cohort study in Ontario, Canada. PLOS One, 12(9), e0184268. doi: 10.1371/journal.pone.0184268CrossRefGoogle ScholarPubMed
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357–1366. doi: 10.1016/s0140-6736(17)32802-7CrossRefGoogle ScholarPubMed
Clarke, C. S., Duffy, L., Lewis, G., Freemantle, N., Gilbody, S., Kendrick, T., … Hunter, R. M. (2022). Cost-utility analysis of discontinuing antidepressants in England primary care patients compared with long-term maintenance: The ANTLER study. Applied Health Economics and Health Policy, 20, 269–282. doi: 10.1007/s40258-021-00693-xCrossRefGoogle ScholarPubMed
Cotterchio, M., Kreiger, N., Darlington, G., & Steingart, A. (1999). Comparison of self-reported and physician-reported antidepressant medication use. Annals of Epidemiology, 9(5), 283–289. doi: 10.1016/s1047-2797(98)00072-6CrossRefGoogle ScholarPubMed
Cuijpers, P., Noma, H., Karyotaki, E., Cipriani, A., & Furukawa, T. A. (2019). Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: A network meta-analysis. JAMA Psychiatry, 76(7), 700–707. doi: 10.1001/jamapsychiatry.2019.0268CrossRefGoogle ScholarPubMed
Davies, J., Pauli-Jones, R., & Montagu, L. (2018). Antidepressant withdrawal: A survey of patients’ experience by the all-party parliamentary group for prescribed drug dependence. Retrieved from https://www.drugsandalcohol.ie/29794/7/APPG-PDD-Survey-of-antidepressant-withdrawal-experiences.pdfGoogle Scholar
Evans-Lacko, S., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., … Thornicroft, G. (2018). Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys. Psychological Medicine, 48(9), 1560–1571. doi: 10.1017/s0033291717003336CrossRefGoogle ScholarPubMed
Fantom, N. J., & Serajuddin, U. (2016). The World Bank's classification of countries by income. World Bank Policy Research Working Paper 7528. Retrieved from https://openknowledge.worldbank.org/entities/publication/336a7f99-b73f-5b16-b36b-6dc49321e971Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, non-patient edition. New York, NY: New York State Psychiatric Institute.Google Scholar
Fornaro, M., Cattaneo, C. I., De Berardis, D., Ressico, F. V., Martinotti, G., & Vieta, E. (2023). Antidepressant discontinuation syndrome: A state-of-the-art clinical review. European Neuropsychopharmacology, 66, 1–10. doi: 10.1016/j.euroneuro.2022.10.005CrossRefGoogle ScholarPubMed
Gardarsdottir, H., Heerdink, E. R., van Dijk, L., & Egberts, A. C. (2007). Indications for antidepressant drug prescribing in general practice in the Netherlands. The Journal of Affective Disorders, 98(1–2), 109–115. doi: 10.1016/j.jad.2006.07.003CrossRefGoogle ScholarPubMed
Gastaldon, C., Schoretsanitis, G., Arzenton, E., Raschi, E., Papola, D., Ostuzzi, G., … Barbui, C. (2022). Withdrawal syndrome following discontinuation of 28 antidepressants: Pharmacovigilance analysis of 31688 reports from the WHO spontaneous reporting database. Drug Safety, 45(12), 1539–1549. doi: 10.1007/s40264-022-01246-4CrossRefGoogle Scholar
GBD 2017 DALYs and HALE Collaborators. (2018). Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1859–1922. doi: 10.1016/s0140-6736(18)32335-3CrossRefGoogle Scholar
Goldstein, B. I., Baune, B. T., Bond, D. J., Chen, P. H., Eyler, L., Fagiolini, A., … Fiedorowicz, J. G. (2020). Call to action regarding the vascular-bipolar link: A report from the vascular task force of the international society for bipolar disorders. Bipolar Disorders, 22(5), 440–460. doi: 10.1111/bdi.12921CrossRefGoogle Scholar
Haro, J. M., Arbabzadeh-Bouchez, S., Brugha, T. S., de Girolamo, G., Guyer, M. E., Jin, R., … Kessler, R. C. (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research, 15(4), 167–180. doi: 10.1002/mpr.196CrossRefGoogle ScholarPubMed
Heeringa, S., Wells, J., Hubbard, F., Mneimneh, Z., Chiu, W., Sampson, N., & Berglund, P. (2008). Sample designs and sampling procedures. In Kessler, R. & Ustun, T. (Eds.), The WHO world mental health surveys: Global perspectives on the epidemiology of mental disorders (pp. 14–32). Cambridge, England: Cambridge University Press.Google Scholar
Henshaw, E. J., & Freedman-Doan, C. R. (2009). Conceptualizing mental health care utilization using the health belief model. Clinical Psychology: Science and Practice, 16(4), 420–439. doi: 10.1111/j.1468-2850.2009.01181.xGoogle Scholar
Herrman, H., Kieling, C., McGorry, P., Horton, R., Sargent, J., & Patel, V. (2019). Reducing the global burden of depression: A Lancet-world psychiatric association commission. Lancet (London, England), 393(10189), e42–e43. doi: 10.1016/s0140-6736(18)32408-5CrossRefGoogle ScholarPubMed
Hosmer, D. W. Jr., Lemeshow, S., & May, S. (2008). Applied survival analysis: Regression modeling of time-to-event data (2nd ed.). Hoboken, NJ: Wiley.CrossRefGoogle Scholar
Ji, N. J., & Hong, Y. P. (2020). Effect of income level on adherence to antidepressant treatment in first onset depression outpatients. PLOS One, 15(9), e0238623. doi: 10.1371/journal.pone.0238623CrossRefGoogle ScholarPubMed
Kato, M., Hori, H., Inoue, T., Iga, J., Iwata, M., Inagaki, T., … Tajika, A. (2021). Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: A systematic review and meta-analysis. Molecular Psychiatry, 26, 118–133. doi: 10.1038/s41380-020-0843-0CrossRefGoogle ScholarPubMed
Kessler, R. C. (2012). The costs of depression. Psychiatric Clinics of North America, 35(1), 1–14. doi: 10.1016/j.psc.2011.11.005CrossRefGoogle ScholarPubMed
Kessler, R. C., & Ustün, T. B. (2004). The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121. doi: 10.1002/mpr.168CrossRefGoogle ScholarPubMed
Kullgard, N., Holmqvist, R., & Andersson, G. (2022). Premature dropout from psychotherapy: Prevalence, perceived reasons and consequences as rated by clinicians. The Journal Clinical Psychology in Europe, 4(2), e6695. doi: 10.32872/cpe.6695CrossRefGoogle ScholarPubMed
Kwon, A., Bungay, K. M., Pei, Y., Rogers, W. H., Wilson, I. B., Zhou, Q., & Adler, D. A. (2003). Antidepressant use: Concordance between self-report and claims records. Medical Care, 41(3), 368–374. doi: 10.1097/01.Mlr.0000053019.79054.B6CrossRefGoogle ScholarPubMed
Lépine, J. P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric Disease and Treatment, 7(Suppl 1), 3–7. doi: 10.2147/ndt.S19617Google ScholarPubMed
Liu, X., Momen, N. C., Molenaar, N., Rommel, A. S., Bergink, V., & Munk-Olsen, T. (2021). Discontinuation of antidepressants: Is there a minimum time on treatment that will reduce relapse risk? The Journal of Affective Disorders, 290, 254–260. doi: 10.1016/j.jad.2021.04.045CrossRefGoogle Scholar
Magaard, J. L., Seeralan, T., Schulz, H., & Brütt, A. L. (2017). Factors associated with help-seeking behaviour among individuals with major depression: A systematic review. PLOS One, 12(5), e0176730. doi: 10.1371/journal.pone.0176730CrossRefGoogle ScholarPubMed
Mojtabai, R., & Olfson, M. (2014). National trends in long-term use of antidepressant medications: Results from the U.S. National Health and Nutrition Examination Survey. The Journal of Clinical Psychiatry, 75(2), 169–177. doi: 10.4088/JCP.13m08443CrossRefGoogle ScholarPubMed
Montoya, A., Lebrec, J., Keane, K. M., Fregenal, I., Ciudad, A., Moríñigo, Á, … Zimmerman, M. (2016). Broader conceptualization of remission assessed by the remission from depression questionnaire and its association with symptomatic remission: A prospective, multicenter, observational study. BMC Psychiatry, 16, 352. doi: 10.1186/s12888-016-1067-3CrossRefGoogle ScholarPubMed
Moshe, I., Terhorst, Y., Philippi, P., Domhardt, M., Cuijpers, P., Cristea, I., … Sander, L. B. (2021). Digital interventions for the treatment of depression: A meta-analytic review. Psychological Bulletin, 147(8), 749–786. doi: 10.1037/bul0000334CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE). (2009). Depression in adults: Recognition and management. Retrieved from https://www.nice.org.uk/guidance/cg90Google Scholar
Olfson, M., Marcus, S. C., Tedeschi, M., & Wan, G. J. (2006). Continuity of antidepressant treatment for adults with depression in the United States. American Journal of Psychiatry, 163(1), 101–108. doi: 10.1176/appi.ajp.163.1.101CrossRefGoogle ScholarPubMed
Samples, H., & Mojtabai, R. (2015). Antidepressant self-discontinuation: Results from the collaborative psychiatric epidemiology surveys. Psychiatric Services, 66(5), 455–462. doi: 10.1176/appi.ps.201400021CrossRefGoogle ScholarPubMed
Scholten, W., Batelaan, N., & Van Balkom, A. (2020). Barriers to discontinuing antidepressants in patients with depressive and anxiety disorders: A review of the literature and clinical recommendations. Therapeutic Advances in Psychopharmacology, 10, 1–10. doi: 10.1177/2045125320933404CrossRefGoogle ScholarPubMed
Scott, K. M., de Jonge, P., Stein, D. J., & Kessler, R. C. (2018). Mental disorders around the world: Facts and figures from the WHO world mental health surveys. Cambridge, England: Cambridge University Press.CrossRefGoogle Scholar
Sirey, J. A., Banerjee, S., Marino, P., Bruce, M. L., Halkett, A., Turnwald, M., … Kales, H. C. (2017). Adherence to depression treatment in primary care: A randomized clinical trial. JAMA Psychiatry, 74(11), 1129–1135. doi: 10.1001/jamapsychiatry.2017.3047CrossRefGoogle ScholarPubMed
Sørensen, A., Jørgensen, K. J., & Munkholm, K. (2022). Description of antidepressant withdrawal symptoms in clinical practice guidelines on depression: A systematic review. The Journal of Affective Disorders, 316, 177–186. doi: 10.1016/j.jad.2022.08.011CrossRefGoogle ScholarPubMed
Tabatabai, M. A., Li, H., Eby, W. M., Kengwoung-Keumo, J. J., Manne, U., Bae, S., … Singh, K. P. (2014). Robust logistic and probit methods for binary and multinomial regression. Journal of Biometrics & Biostatistics, 5(4), 202. doi: 10.4172/2155-6180.1000202Google ScholarPubMed
Tanner, J. A., Hensel, J., Davies, P. E., Brown, L. C., Dechairo, B. M., & Mulsant, B. H. (2020). Economic burden of depression and associated resource use in Manitoba, Canada. The Canadian Journal of Psychiatry, 65(5), 338–346. doi: 10.1177/0706743719895342CrossRefGoogle ScholarPubMed
Van Leeuwen, E., van Driel, M. L., Horowitz, M. A., Kendrick, T., Donald, M., De Sutter, A. I., … Christiaens, T. (2021). Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. Cochrane Database of Systematic Reviews (4), CD013495. doi: 10.1002/14651858.CD013495.pub2Google ScholarPubMed
Wang, Y. H., Li, J. Q., Shi, J. F., Que, J. Y., Liu, J. J., Lappin, J. M., … Bao, Y. P. (2020). Depression and anxiety in relation to cancer incidence and mortality: A systematic review and meta-analysis of cohort studies. Molecular Psychiatry, 25(7), 1487–1499. doi: 10.1038/s41380-019-0595-xCrossRefGoogle ScholarPubMed
Warden, D., Rush, A. J., Trivedi, M. H., Fava, M., & Wisniewski, S. R. (2007). The STAR*D project results: A comprehensive review of findings. Current Psychiatry Reports, 9(6), 449–459. doi: 10.1007/s11920-007-0061-3CrossRefGoogle ScholarPubMed
Wells, T. T., Clerkin, E. M., Ellis, A. J., & Beevers, C. G. (2014). Effect of antidepressant medication use on emotional information processing in major depression. American Journal of Psychiatry, 171(2), 195–200. doi: 10.1176/appi.ajp.2013.12091243CrossRefGoogle ScholarPubMed
Wolter, K. (1985). Introducation to variance estimation. New York, NY: Springer-Verlag.Google Scholar
World Health Organization. (2017). Depression and other common mental disorders: Global health estimates. Retrieved from https://apps.who.int/iris/handle/10665/254610Google Scholar
Wu, C. S., Shau, W. Y., Chan, H. Y., Lee, Y. C., Lai, Y. J., & Lai, M. S. (2012). Utilization of antidepressants in Taiwan: A nationwide population-based survey from 2000 to 2009. Pharmacoepidemiology and Drug Safety, 21(9), 980–988. doi: 10.1002/pds.3255CrossRefGoogle ScholarPubMed
Yamabe, K., Liebert, R., Flores, N., & Pashos, C. L. (2019). Health-related quality of life outcomes, economic burden, and associated costs among diagnosed and undiagnosed depression patients in Japan. ClinicoEconomics and Outcomes Research, 11, 233–243. doi: 10.2147/ceor.S179901CrossRefGoogle ScholarPubMed
Kazdin et al. supplementary material
Kazdin et al. supplementary material
File
50 KB