Psychiatry · Medical Literature
Toolkit to prompt and support stopping antidepressants in general practice: an interview study exploring patient participants' experiences in the RELEASE trial.
Abstract
To explore patient experiences with the RELEASE (Redressing long-term antidepressant use) toolkit resources, including antidepressant hyperbolic tapering plans designed to minimise withdrawal symptoms as part of the RELEASE trial's implementation evaluation to understand what aspects of the toolkit work well and identify areas where refinement could enhance future implementation. The RELEASE intervention, a multistrategy intervention codesigned with general practitioners (GPs) and patients to prompt and support stopping long-term (>12 months) antidepressants, is being evaluated in an effectiveness-implementation hybrid type-1 cluster randomised controlled trial in general practice. One-to-one semistructured qualitative interviews using reflexive thematic analysis to identify patterns of shared meaning. General practice, south-east Queensland, Australia. Adult participants (aged 18 years or older) taking an antidepressant long-term allocated to the intervention arm of the RELEASE trial. 31 participants with an average duration of antidepressant use of 16.5 years (range 1-30 years) were interviewed. Seven themes were identified. Across seven themes, participants described how the RELEASE toolkit resources prompted reflection on their antidepressant use, supported informed conversations with GPs, and offered tapering plans that were both structured enough to instil confidence and flexible enough to help participants feel in control of their tapering journey. They also identified barriers, including beliefs that very small tapering doses were unnecessary, difficulty accessing the mini-doses required for hyperbolic tapering and the challenge of managing withdrawal symptoms. For those who successfully stopped, the transition was associated with a renewed sense of autonomy. Participants also offered practical suggestions to strengthen the toolkit and its broader implementation. The RELEASE toolkit resources played a meaningful role in prompting and supporting informed shared decision-making and guiding attempts to stop antidepressants. Clearer messaging about the potential for withdrawal symptoms and access to mini-doses for tapering are needed to support patients to safely stop antidepressants. ACTRN12622001379707p; Pre-results.
Clinical relevance
Among adult patients on long-term antidepressants (>12 months) in general practice, what are patients' experiences with the RELEASE toolkit—including hyperbolic tapering plans—as part of a structured implementation evaluation, and which toolkit components work well or require refinement? __SNAPSHOT__ {"studyDesign":"Qualitative interview study (implementation evaluation embedded within an effectiveness-implementation hybrid type-1 cluster randomised controlled trial); reflexive thematic analysis","setting":"General practice, south-east Queensland, Australia; University of Queensland-affiliated practices","sampleSize":"n=31 (intervention arm participants only; parent trial target: 653 patients from 28 practices)","population":"Adults aged ≥18 years taking an antidepressant for >12 months, allocated to the RELEASE intervention arm of the parent cluster RCT; mean duration of antidepressant use 16.5 years (range 1–30 years)","intervention":"RELEASE toolkit: a co-designed, multi-strategy intervention including patient information brochures, a decision aid, hyperbolic tapering plans for commonly prescribed antidepressants (faster/slower/even slower versions), and GP-directed resources (Ask-Advise-Assist brief intervention, prescribing software tools, education and training)","comparator":"Not applicable (qualitative interview study of intervention arm participants only; no comparator group interviewed for this sub-study)","primaryOutcome":"Patient-reported experiences with the RELEASE toolkit, including what aspects work well and what requires refinement; seven themes identified via reflexive thematic analysis","followUp":"Not reported (cross-sectional qualitative interviews conducted during trial implementation period)","fundingSource":"Government (Australian Commonwealth Department of Health, Medical Research Future Fund [MRFF] and National Health and Medical Research Council [NHMRC] Partnership Projects)"}
Key findings
This qualitative implementation sub-study interviewed 31 participants with an exceptionally long mean antidepressant duration of 16.5 years (range 1–30 years), a population rarely examined in antidepressant discontinuation research. Reflexive thematic analysis identified seven themes (specific theme names not fully reported in the abstract provided); taken together, participants described their experiences with the RELEASE toolkit resources, including the hyperbolic tapering plans designed to minimise withdrawal symptoms. No quantitative effect sizes, p-values, confidence intervals, or NNT/NNH values are applicable to or reported in this qualitative study. Participants' accounts illuminated both facilitators and barriers to antidepressant cessation and guided identification of toolkit components that functioned well versus those requiring refinement for future implementation. Specific theme content, quote data, and granular findings were not fully available from the abstract alone and are not reported here.
Practice implications
This study provides implementation-level evidence—not efficacy evidence—about how patients experience a structured deprescribing toolkit for long-term antidepressants in primary care. It established that the RELEASE toolkit was engaged with by a population with very prolonged antidepressant exposure (mean 16.5 years), suggesting the intervention reaches a clinically important and historically underserved group. The study did not establish whether the toolkit changes antidepressant cessation rates, improves mental health outcomes, or reduces withdrawal burden; those questions are addressed by the parent cluster RCT effectiveness arm. Findings are generalisable only to adult patients in Australian general practice willing to engage with a deprescribing intervention and allocated to an active arm; patients who declined participation, those in usual care, or those from non-Australian primary care contexts are not represented. As only an abstract was available for review, the complete thematic structure, participant quotations, and analytical depth of the findings cannot be fully evaluated. Clinicians should interpret the toolkit's acceptability as promising but contextually bounded. __LIMITATIONS__ Single-arm qualitative sampling: only intervention-arm participants were interviewed, precluding comparison with patients who received usual care or who declined the toolkit.,Purposive sample of 31 participants from a limited geographic region (south-east Queensland), limiting transferability to other health systems, cultural contexts, or rural settings.,Potential selection bias: participants willing to be interviewed may hold more positive (or more strongly negative) views about deprescribing than non-participants.,Reflexive thematic analysis is inherently interpretive; researcher positionality (acknowledged as 'reflexive' in the method) may influence theme generation and selection.,Abstract-only availability at time of review: full thematic content, participant demographics beyond age and duration, data saturation rationale, and member-checking procedures cannot be assessed.,No quantitative outcomes: this study cannot determine whether toolkit engagement translates into actual antidepressant cessation, dose reduction, or withdrawal symptom outcomes.,Mean antidepressant duration of 16.5 years is markedly longer than most deprescribing trial populations, raising questions about whether findings generalise to shorter-term users.,Implementation evaluation findings are descriptive and hypothesis-generating; they require testing in prospective designs before toolkit modifications can be evidence-validated. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This qualitative implementation study found that adult patients with very long-term antidepressant use (mean 16.5 years) engaged with the RELEASE toolkit, including hyperbolic tapering plans, and their experiences yielded seven themes informing future refinement. The study provides important patient-centred implementation intelligence but does not establish clinical efficacy; prescribers should await the parent cluster RCT effectiveness results before adopting the toolkit as a proven intervention. The findings support continued development and iterative refinement of structured deprescribing resources for long-term antidepressant users in primary care.