Depression: The Patient Experience of Stopping

Antidepressant Medication

Penny Louch15th November 2008

2

Presentation Plan

• Depression in context

• Rationale for study

• Theoretical framework

• Study design

• Findings

3

Global Burden of Depression

Injuries13%

Communicable Diseases; Maternal

and Perinatal Conditions; Nutritional

Deficiencies39%

Other Chronic Diseases

16%

Other Neuropsychiatric Disorders

8%

Depression4%

Diabetes1%

Cardiovascular Disease

10% Cancer5% Chronic Respiratory

Diseases4%

• WHO. The World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva: WHO, 2001

• WHO. World Health Statistics 2006. 2006. France, WHO.

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European Burden of Depression

Cardiovascular Disease19%

Cancers17%

Depression8%

Bipolar & Schizophrenia2%

Musculoskeletal Diseases4%

Communicable Diseases; Maternal and Perinatal Conditions; Nutritional

Deficiencies5% Digestive Diseases

5%Chronic Respiratory

Diseases5%

Other Neuropsychiatric Disorders

5%

Diabetes2%

Alzheimer's & Other Dementias

6%

Injuries8%

Alcohol & Drug Use Disorders

6%

Other Diseases8%

• WHO. The European Health Report 2002. 2002. Copenhagen, Denmark, WHO Regional Officefor Europe.

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The Burden of Depression

11 in 33 Families Experience Depression

• Personal• Family• Social• Economic

• Office for National Statistics. Psychiatric Morbidity in Great Britain, 2000, Prevalence of Psychiatric Morbidity Among Adults Living in Private Households. London: HMSO, 2001. • The Centre for Economic Performance's Mental Health Policy Group. The Depression Report: New Deal for Depression and Anxiety Disorders. London: London School of Economics, 2006.

Prevalence of Depression

0

5

10

15

20

25

30

35

40

45

50

16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

Age

Ra

te p

er

10

00

po

pu

lati

on

M

F

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Depression Diagnosis in Primary Care

• Lepine JP, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: The first pan-European study DEPRES (Depression Research in European Society). Int.Clin.Psychopharmacol. 1997;12:19-29.

Rule of Halves

Adherent to Antidepressants

4.5%

NOT Adherent to Antidepressants

4.5%

Patients sought treatment: Depression

NOT Diagnosed39%

Patients did NOT seek treatment for

depression symptoms

43%

Depression Diagnosed: NO antidepressants

9%

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Rationale for the Study

• Previous research– Quantitative and biomedical– Few studies about stopping antidepressants

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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?”

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Explanatory Model Theory

• Kleinman

• 5 parts of an illness experience

1. Aetiology of the illness

2. Time and mode of onset of symptoms

3. Pathophysiology

4. Course of the illness (includes both degree of severity and type of sick role i.e. acute, chronic, impaired)

5. Treatment of the illness

• Kleinman A. Patients and healers in the context of culture. Berkeley, CA: University of California Press, 1980.

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Study Design

• General practice

• Data collection – Questionnaire

– Interviews

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Questionnaire sent to

572 patients

In-depth interview with

30 patients

Patients aged 18-100+ years;

depression diagnosed 6/12 or more; primary care only;

taking antidepressants

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Questionnaire

Kleinman’s 8 Questions Link to 5 Parts of an

Illness experience 1. What do you call your problem? What name does it

have?

2. What do you think has caused your problem? Aetiology

3. Why do you think it started when it did? Time of onset

4. What does your illness do to you? How does it work? Pathophysiology

5. How severe is it? Will it have a short or long course Course

6. What do you fear most about your illness?

7. What are the chief problems your illness has caused for 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?

Treatment

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Questionnaire Responses

Questionnaires sent: 572

Returned questionnaires 202 (35%)

Decline slips 229 (40%)

Non-responders: 141 (25%)

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Data Analysis• Questionnaires:

– QSR N6• Qualitative data analysis computer software tool

• Interviews:– Framework

• Thematic approach• Data indexed and charted according to key issues

and themes

– NVivo

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Findings

• A trajectory towards madness?

• Depression - A chemical imbalance?

• Antidepressants – friend or foe?

• Self

• Stopping antidepressants

• Recovery

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Conclusions

• Multiple insights

• Clinician-researcher role

• Interview process

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Thank You

Email

p.louch@ucl.ac.uk

Website

www.depression-primarycare.co.uk