Patient's decision making regarding antidepressant use

2008 ◽  
Author(s):  
A. Dijkstra ◽  
M. Jaspers ◽  
M. van Zwieten
Keyword(s):  
Decision Making ◽  
Antidepressant Use

scholarly journals GPs’ insights about discontinuing long-term antidepressant use: a qualitative study

2021 ◽  
pp. BJGP.2020.0913
Author(s):  
Maria Donald ◽  
Riitta Partanen ◽  
Leah Sharman ◽  
Johanna Lynch ◽  
Genevieve A Dingle ◽  
...  
Keyword(s):  
Decision Making ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Relational Context ◽  
Qualitative Interview Study ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Antidepressant Use ◽  
Set Up

Background: There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term rather than new prescriptions. Most antidepressant prescriptions are generated in general practice and it is likely that attempts to discontinue are either not occurring or are proving unsuccessful. Aim: To explore GPs’ insights about long-term antidepressant prescribing. Design and Setting: A qualitative interview study with Australian GPs. Method: Semi-structured interviews explored GPs’ discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis. Results: Three overarching themes were identified from interviews with 22 GPs. The first, ‘Not a simple deprescribing decision’, speaks to the complex decision-making GPs undertake in determining whether a patient is ready to discontinue. The second, ‘A journey taken together’ captures a set of steps GPs take together with their patients to initiate and set-up adequate support before, during and after discontinuation. The third: ‘Supporting change in GPs’ prescribing practices’ describes what GPs would like to see change to better support them and their patients to discontinue antidepressants. Conclusions: GPs see discontinuation of long-term antidepressant use as more than a simple deprescribing decision. It begins with considering a patients’ social and relational context and is a journey involving careful preparation, tailored care and regular review. These insights suggest interventions to redress long-term use will need to take these considerations into account and be placed in a wider discussion about the use of antidepressants.

scholarly journals Antidepressant Use Amongst College Students: Findings of a Phenomenological Study

2012 ◽  
Vol 3 (2) ◽  
Author(s):  
Reshmi L. Singh ◽  
Jon C. Schommer ◽  
Marcia M. Worley ◽  
Cynthia Peden-McAlpine
Keyword(s):  
College Students ◽  
Decision Making ◽  
Phenomenological Study ◽  
Treatment Decision ◽  
Health Clinic ◽  
Original Research ◽  
Depression Treatment ◽  
Treatment Decision Making ◽  
Bulletin Boards ◽  
Antidepressant Use

Background: Depression among college students is an escalating problem and could have serious consequences such as suicide. There has been an increase in use of antidepressants on college campuses in United States. However, an in depth understanding of this phenomenon from the college student's perspective is lacking in the literature. Objective: This study examined college students' experiences and treatment decision making during their depression treatment. Methods: A longitudinal, phenomenological research methodology was completed. The participants were nine students who were taking antidepressants for diagnosis of depression. Recruitment was done via brochures placed at University bulletin boards, and a mental health clinic. Three audio taped, unstructured interviews were conducted with each participant over four months. The central question asked was: What has the experience of treating depression been for you? Analysis of text was done using Van Manen's lifeworld existentials of lived body, lived time, lived relation and lived space as the organizing framework. Results: Thirteen themes were identified within the four lifeworlds. The results showed that lived relation with providers was important for college students' decision to both initiate and continue antidepressant use. Students' role was defined in conjunction with provider's role by them as wanting to be a 'player' in their treatment decisions and needing to be 'acknowledged' as such by their providers. Conclusions: Overall, the underlying essential theme of ‘autonomy’ was portrayed by the students’ experiential accounts of their depression treatment and treatment decision making.   Type: Original Research

Women's decision making about antidepressant use during pregnancy: A narrative review

2018 ◽  
Vol 35 (12) ◽  
pp. 1158-1167 ◽  
Author(s):  
Catriona Hippman ◽  
Lynda G. Balneaves
Keyword(s):  
Decision Making ◽  
Narrative Review ◽  
Antidepressant Use

scholarly journals Depression, antidepressants and fall risk: therapeutic dilemmas—a clinical review

2021 ◽  
Author(s):  
E. P. van Poelgeest ◽  
A. C. Pronk ◽  
D. Rhebergen ◽  
N. van der Velde
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Clinical Review ◽  
Side Effect ◽  
Fall Risk ◽  
Older Persons ◽  
Clinical Decision Making ◽  
Elderly Persons ◽  
Side Effect Profile ◽  
Antidepressant Use

Abstract Purpose The aim of this clinical review was to summarize the existing knowledge on fall risk associated with antidepressant use in older adults, describe underlying mechanisms, and assist clinicians in decision-making with regard to (de-) prescribing antidepressants in older persons. Methodology We comprehensively examined the literature based on a literature search in Pubmed and Google Scholar, and identified additional relevant articles from reference lists, with an emphasis on the most commonly prescribed drugs in depression in geriatric patients. We discuss use of antidepressants, potential fall-related side effects, and deprescribing of antidepressants in older persons. Results Untreated depression and antidepressant use both contribute to fall risk. Antidepressants are equally effective, but differ in fall-related side effect profile. They contribute to (or cause) falling through orthostatic hypotension, sedation/impaired attention, hyponatremia, movement disorder and cardiac toxicity. Falling is an important driver of morbidity and mortality and, therefore, requires prevention. If clinical condition allows, withdrawal of antidepressants is recommended in fall-prone elderly persons. An important barrier is reluctance of prescribers to deprescribe antidepressants resulting from fear of withdrawal symptoms or disease relapse/recurrence, and the level of complexity of deprescribing antidepressants in older persons with multiple comorbidities and medications. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antidepressants. Conclusions (De-) prescribing antidepressants in fall-prone older adults is often challenging, but detailed insight in fall-related side effect profile of the different antidepressants and a recently developed expert-based decision aid STOPPFalls assists prescribers in clinical decision-making.

OP128 Evaluating The NPS MedicineWise Medicines Information Phone Service

2018 ◽  
Vol 34 (S1) ◽  
pp. 49-49
Author(s):  
Lauren Humphreys ◽  
Nerida Packham ◽  
Suzanne Blogg ◽  
Nicole Gonzaga ◽  
Scott Dickinson ◽  
...  
Keyword(s):  
Decision Making ◽  
Side Effects ◽  
Professional Education ◽  
Evidence Based ◽  
Knowledge Gaps ◽  
Future Health ◽  
Medicines Information ◽  
Drug Knowledge ◽  
Antidepressant Use ◽  
Phone Service

Introduction:The NPS MedicineWise pharmacist-delivered phone service, Medicines Line, aims to provide evidence-based medicines information to consumers. We evaluated outcomes of the Medicines Line, including common consumer inquiries and resultant decision-making, and explored consumer motivations for seeking medicines information.Methods:The evaluation involved conducting paper-based and telephone surveys of a sample of 200 Medicines Line callers, and semi-structured telephone interviews of a subset of twenty callers. Quantitative data were analyzed using SPSS software. Qualitative data were analyzed using content analysis.Results:Preliminary analysis found that the majority of callers thought the Medicines Line had improved their knowledge (ninety-six percent), confidence (eighty-two percent) and decision-making (eighty-nine percent). The most common reasons for calling the Medicines Line were inquiries about side effects or medicine compatibility. The medicines most commonly asked about were antidepressants (twenty percent), analgesics (thirteen percent) and antibiotics (nine percent). Questions about sertraline accounted for thirty-six percent of antidepressant inquiries. Interview themes regarding motivations for using the service included: trust; efficiency and convenience; specialized drug knowledge; and reporting adverse drug reactions to protect others from medicine-related harm. Medicines Line was perceived to be especially useful as an alternative to family physician or specialist consultations when consumers had a non-urgent inquiry about a medicine, and as a service to provide medicines information in remote communities.Conclusions:These results indicate that pharmacist-delivered medicines information telephone services are an effective and efficient way of handling medicines inquiries. Medicines information telephone services are effective in improving health literacy, by increasing callers’ knowledge and confidence to source evidence-based medicines information and improving their ability to make informed decisions about medicine use. This evaluation identified knowledge gaps in medicine side effects and antidepressant use. Identifying such knowledge gaps may be useful in informing future health professional education programs, community campaigns, and shared decision-making resources.

Determinants of women's decision making regarding gestational antidepressant use

2003 ◽  
Vol 55 (2) ◽  
pp. 135
Author(s):  
LA Sonari ◽  
A Einarson ◽  
J Jasper ◽  
G Koren
Keyword(s):  
Decision Making ◽  
Antidepressant Use

scholarly journals Patient decision aids for antidepressant use in pregnancy: a pilot randomised controlled trial in the UK

BJGP Open ◽  
2019 ◽  
Vol 3 (4) ◽  
pp. bjgpopen19X101666 ◽  
Author(s):  
Hind Khalifeh ◽  
Emma Molyneaux ◽  
Ruth Brauer ◽  
Simone Vigod ◽  
Louise M Howard
Keyword(s):  
Decision Making ◽  
Controlled Trial ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Patient Decision ◽  
Antidepressant Use ◽  
Online Access ◽  
Randomised Controlled ◽  
In Pregnancy

BackgroundDecision-making regarding antidepressant use in pregnancy is challenging, given the uncertain evidence base on the benefits and risks for women and their children. Patient decision aids (PDAs) can improve shared decision-making for complex health decisions but no evidence-based PDAs exist for antidepressant use in pregnancy.AimTo assess the feasibility of a full-scale randomised controlled trial (RCT) to evaluate the efficacy of an electronic PDA on antidepressant use in pregnancy.Design & settingA UK-based pilot parallel-group RCT.MethodThe study recruited women whose clinicians recommended an antidepressant for depression in a current or planned pregnancy, and who were uncertain about antidepressant use while pregnant. Women were recruited via clinician or self-referral, and randomised to online access to the PDA or online access to standard resource list, with primary follow-up at 4 weeks and longer-term follow-up. The primary outcome was protocol feasibility (recruitment target of 50 women and follow-up rate of 80%). Outcome measures for a future full-scale RCT included the decisional conflict scale (DCS).ResultsFifty-one women were recruited with a follow-up rate of 90.2% at 4 weeks. The PDA received good overall satisfaction ratings (mean 4.2/5). Analysis of covariance (ANCOVA) indicated a small improvement in decisional conflict at 4 weeks, accounting for baseline scores (DCS regression coefficient = -3.5, 95% confidence intervals [CI = -12.6 to 5.6]).ConclusionThis pilot RCT for an electronic PDA on antidepressant use in pregnancy showed that the study protocol was feasible, with high rates of participant satisfaction among those randomised to the PDA.

Discarding optimality: Throwing out the baby with the bathwater?

2018 ◽  
Vol 41 ◽  
Author(s):  
Patrick Simen ◽  
Fuat Balcı
Keyword(s):  
Decision Making ◽  
Perceptual Decision Making ◽  
Reward Rate ◽  
Perceptual Decision ◽  
Standard Observer ◽  
Rate Maximization ◽  
Reward Rate Maximization ◽  
Descriptive Standard ◽  
Observer Model

AbstractRahnev & Denison (R&D) argue against normative theories and in favor of a more descriptive “standard observer model” of perceptual decision making. We agree with the authors in many respects, but we argue that optimality (specifically, reward-rate maximization) has proved demonstrably useful as a hypothesis, contrary to the authors’ claims.

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