Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys.
Journal: Psychological medicine
Volume: 54
Issue: 1
Year of Publication: 2024
Affiliated Institutions:
Department of Psychology, Yale University, New Haven, CT, USA.
School of Public Health, The University of Queensland, Herston, QLD , Australia.
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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.
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil.
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan Town, Taiwan.
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Anxiety Disorders Research Center, Buenos Aires, Argentina.
Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands.
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.
Institut de Psychologie, EA , Université Paris Cité, Paris, France.
Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Salud Mental, Servicio Murciano de Salud, Murcia, Spain.
Instituto Nacional de Salud, Lima, Peru.
Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia.
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
National Institute for Health Services Management, Bucharest, Romania.
Abstract summary
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.Face-to-face interviews with community samples from 13 countries ( = 30 697) in the World Mental Health (WMH) Surveys included = 1890 respondents who used ADMs within the past 12 months.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.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.
Authors & Co-authors:
Kazdin Alan E AE
Harris Meredith G MG
Hwang Irving I
Sampson Nancy A NA
Stein Dan J DJ
Viana Maria Carmen MC
Vigo Daniel V DV
Wu Chi-Shin CS
Aguilar-Gaxiola Sergio S
Alonso Jordi J
Benjet Corina C
Bruffaerts Ronny R
Caldas-Almeida José Miguel JM
Cardoso Graça G
Caselani Elisa E
Chardoul Stephanie S
Cía Alfredo A
de Jonge Peter P
Gureje Oye O
Haro Josep Maria JM
Karam Elie G EG
Kovess-Masfety Viviane V
Navarro-Mateu Fernando F
Piazza Marina M
Posada-Villa José J
Scott Kate M KM
Stagnaro Juan Carlos JC
Ten Have Margreet M
Torres Yolanda Y
Vladescu Cristian C
Kessler Ronald C RC
Study Outcome
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