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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

Alan E. Kazdin
Affiliation:
Department of Psychology, Yale University, New Haven, CT, USA
Meredith G. Harris
Affiliation:
School of Public Health, The University of Queensland, Herston, QLD 4006, Australia Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
Irving Hwang
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Nancy A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Dan J. Stein
Affiliation:
Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa Groote Schuur Hospital, Cape Town, South Africa
Maria Carmen Viana
Affiliation:
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
Daniel V. Vigo
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Chi-Shin Wu
Affiliation:
National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan Town, Taiwan
Sergio Aguilar-Gaxiola
Affiliation:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
Jordi Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain Department of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Corina Benjet
Affiliation:
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Ronny Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
José Miguel Caldas-Almeida
Affiliation:
Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
Graça Cardoso
Affiliation:
Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
Elisa Caselani
Affiliation:
Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Stephanie Chardoul
Affiliation:
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
Alfredo Cía
Affiliation:
Anxiety Disorders Research Center, Buenos Aires, Argentina
Peter de Jonge
Affiliation:
Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, The Netherlands
Oye Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Josep Maria Haro
Affiliation:
Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Centre for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain Departament de Medicine, Universitat de Barcelona, Barcelona, Spain
Elie G. Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Viviane Kovess-Masfety
Affiliation:
Institut de Psychologie, EA 4057, Université Paris Cité, Paris, France
Fernando Navarro-Mateu
Affiliation:
Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Salud Mental, Servicio Murciano de Salud, Murcia, Spain Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain CIBER Epidemiology and Public Health-Murcia (CIBERESP-Murcia), Murcia, Spain
Marina Piazza
Affiliation:
Instituto Nacional de Salud, Lima, Peru Universidad Cayetano Heredia, Lima, Peru
José Posada-Villa
Affiliation:
Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
Kate M. Scott
Affiliation:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
Juan Carlos Stagnaro
Affiliation:
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
Margreet ten Have
Affiliation:
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
Yolanda Torres
Affiliation:
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
Cristian Vladescu
Affiliation:
National Institute for Health Services Management, Bucharest, Romania
Ronald C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
Corresponding author: Ronald C. Kessler; Email: kessler@hcp.med.harvard.edu

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
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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