1. Penny Louch 15th November 2008
Depression: The Patient Experience of Stopping Antidepressant Medication
Penny Louch
15th November 2008

2. Presentation Plan
Depression in context
Rationale for study
Theoretical framework
Study design
Findings

3. Global Burden of Depression
WHO. The World Health Report Mental Health: New Understanding, New Hope. Geneva: WHO, 2001
WHO. World Health Statistics France, WHO.

4. European Burden of Depression
WHO. The European Health Report Copenhagen, Denmark, WHO Regional Officefor Europe.

5. The Burden of Depression
Personal
Family
Social
Economic
1 in 3 Families Experience Depression
Personal:
Affects approx 1:5 people at some point in their lives
Men with depression have signicantly increased risk for subsequent CHD (Ford et al)
Depression is an independent risk factor for mortality (RR1.81) (Cuijpers 2002 meta-analysis), not only major depression but also milder and subclinical forms of depression. Depression-mortality effect is accounted for by a few items reflecting motivational depletion (Schulz 2000)
Women increased depression risks through childbearing and working years
Men increased depression risk at peak of working lives years
Family:
Depression affects 1:3 families, major impact on quality of life of both sufferer and the family
Results in:
A huge impact on the social and economic lives of individuals and their families
Depression reduces economic output through time off-sick, non-employment and unemployment
Currently more people on incapacity benefits due to mental health problems than the total number of unemployed people on Job Seeker’s Allowance.
Primary care:
Approximately 10% of patients who consult their GP meet the criteria for mild or moderate depression, this represents one third of the mental health burden in general practice (Blacker 1988; Freeling 1985; Coyne 1994).
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.

6. Depression Diagnosis in Primary Care
Rule of Halves
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.

7. Rationale for the Study
Previous research
Quantitative and biomedical
Few studies about stopping antidepressants

8. 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?”

9. Explanatory Model Theory
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
5 parts of an illness experience
Kleinman A. Patients and healers in the context of culture. Berkeley, CA: University of California Press, 1980.

10. Study Design
General practice
Data collection
Questionnaire
Interviews

11. Patients aged 18-100+ years;
depression diagnosed 6/12 or more; primary care only;
taking antidepressants
Questionnaire sent to
572 patients
In-depth interview with
30 patients

12. Link to 5 Parts of an Illness experience
Questionnaire
Kleinman’s 8 Questions
Link to 5 Parts of an Illness experience
What do you call your problem? What name does it have?
What do you think has caused your problem?
Aetiology
Why do you think it started when it did?
Time of onset
What does your illness do to you? How does it work?
Pathophysiology
How severe is it? Will it have a short or long course
Course
What do you fear most about your illness?
What are the chief problems your illness has caused for you?
What kind of treatment do you think you should receive? What are the most important results you hope to receive from the treatment?
Treatment

13. Questionnaire Responses
Questionnaires sent:
572
Returned questionnaires
202 (35%)
Decline slips
229 (40%)
Non-responders:
141 (25%)

14. Data Analysis Questionnaires: Interviews: QSR N6 Framework NVivo
Qualitative data analysis computer software tool
Interviews:
Framework
Thematic approach
Data indexed and charted according to key issues and themes
NVivo

15. Findings
A trajectory towards madness?
Depression - A chemical imbalance?
Antidepressants – friend or foe?
Self
Stopping antidepressants
Recovery

16. Conclusions
Multiple insights
Clinician-researcher role
Interview process

17. Thank You Email p.louch@ucl.ac.uk Website