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

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

Global Burden of Depression WHO. The World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva: WHO, 2001 WHO. World Health Statistics 2006. 2006. France, WHO.

European Burden of Depression WHO. The European Health Report 2002. 2002. Copenhagen, Denmark, WHO Regional Officefor Europe.

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 - 35-64 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.

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.

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

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?”

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.

Study Design General practice Data collection Questionnaire Interviews

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

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

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

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

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

Conclusions Multiple insights Clinician-researcher role Interview process

Thank You Email p.louch@ucl.ac.uk Website www.depression-primarycare.co.uk