REDUCE

Summary

There is considerable concern about increasing antidepressant use in England. GPs are writing more than 60 million prescriptions a year, to around 1-in-10 adults. Some people need long-term antidepressants to stop them getting depressed, but a third-to-a-half could possibly stop them without relapsing. However, stopping is not always easy. Some patients may experience withdrawal symptoms, while others may be fearful that they will experience them.   

People taking antidepressants have told us their GPs often do not review them and just give repeat prescriptions. Studies show that when GPs review patients on long-term antidepressants and advise them where appropriate to withdraw, only 1 in 14 is able to stop. Patients can be fearful and withdrawal can be tricky so GPs and Nurse Practitioners (NPs) who prescribe anti-depressants need to guide patients who want to withdraw, and patients need around the clock support. 

Research Programme Aims:

• Identify feasible, safe, effective, and cost-effective ways of helping patients taking long-term antidepressants taper off and stop treatment, when appropriate. 
• Check the usefulness of the programme in helping patients stop treatment through a randomised controlled trial in three centres (Southampton, Liverpool and Hull universities), and estimate financial benefits for the NHS. 
• Assess the effectiveness of the Internet and telephone interventions, in terms of reductions in antidepressant use in the absence of worsening of depression, and assess patients’ and practitioners’ use of the interventions   
• A qualitative process evaluation will be conducted through open-ended interviews with 15-20 patients and 15-20 practitioners in each arm.  
• We will also look at the use of the telephone support provided by psychological practitioners (PWPs), and any technical support needed for patients to be able to use the internet intervention.   
• Finally, we will explore why the interventions were effective or not, depending on the results. 

This research is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Health Research (PGfAR) programme (project number RP-PG-1214-20004), and is supported by the NIHR Clinical Research Network (CRN).