Background:

Many antidepressant users experience the process of stopping as challenging because of withdrawal symptoms. Support factors, such as patients experiencing empathy from their healthcare providers, potentially contribute to successful discontinuation.

Objectives:

To examine the relation between experienced empathy and successful antidepressant discontinuation.

Design:

Part of a larger prospective cohort study in major depressive disorder patients using sertraline or citalopram recruited through university medical centres and connected general practitioners, pharmacies and mental health institutions. The larger study aimed to identify factors associated with remission and patients’ experiences with discontinuing antidepressants.

Method:

Patients were followed for 24 months. We measured objective and subjective discontinuation success. Subjective discontinuation was measured with the Discontinuation Success Scale, a scale with three subscales (subjective feeling of success, positive and negative effects of discontinuation). Empathy was measured with the Consultation and Relational Empathy (CARE) measure. To analyse the association between perceived empathy and discontinuation success, we used regression analyses.

Results:

Of 918 participants in the larger study, 235 attempted discontinuation and 153 could be included in the analysis. About two-thirds of the participants were successful in discontinuing antidepressant medication. We did not find an association between perceived empathy and objective discontinuation success. Perceived empathy was positively associated with subjective success and negatively associated with the negative effects of discontinuation.

Conclusion:

Although we could not demonstrate an association of perceived empathy and objective discontinuation, we consider the finding of a relation between subjective success as relevant because a successful experience regarding antidepressant discontinuation may positively influence the initiation of future attempts.

Plain language summary

The role of empathy in antidepressant withdrawal

Stopping antidepressant medication is sometimes very difficult because part of the patients experience serious adverse effects when stopping, leading to unsuccessful withdrawal. Apart from the technical aspects of withdrawal (dosage, speed) non-specific factors are important for successful discontinuation. Non-specific factors are for example the quality of the relation between patient and professional or the patients’ expectations prior to the discontinuation process. An important element in the quality of the relation is the empathy patients experience from the healthcare professional. We were able to study the role of empathy in a subsample of a larger study; 153 patients attempting to discontinue their antidepressant. Of the 153 participants 98 were successful in stopping the antidepressant medication. We found no relation between perceived empathy and successful stopping the antidepressant medication. We did find a relation between perceived empathy and negative symptoms experienced during the discontinuation process: the higher the experienced empathy, the less bothersome the discontinuation process. We recommend an empathic attitude from healthcare professionals towards their patients when they attempt to stop the antidepressant. We also recommend further research into other elements of the quality of the relation (genuineness, trust, feeling of alliance) and expectations of patients prior to stopping).

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The role of empathy in antidepressant withdrawal

Reporting on Adverse Clinical Events