Better safe than sorry — why patients prefer to stop using selective serotonin reuptake inhibitor (SSRI) antidepressants but are afraid to do so: results of a qualitative study

Abstract

Background: Patients need to be informed not only about the effects and side-effects of their prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs), but also about the consequences of stopping treatment with this medication. However, the professional guidelines on how to inform patients about stopping are not well developed and no consensus has yet been reached. This study focuses on the dilemmas involved in continuing or stopping the use of SSRIs from the perspective of the users and explores why these dilemmas tend to be solved by continuing rather than stopping.

Methods: A qualitative study of the views of 16 SSRI users in The Netherlands was performed. Most interviews were conducted at the subject's own home, and all were tape-recorded with permission, and transcribed verbatim. The analysis is based on grounded theory, aiming at the systematic development of theories and hypotheses through the inspection of interview responses. Emerging themes were discussed and refined using the constant comparative method.

Results: The SSRI users in this study had reached a certain balance after a period of trial and error. Feeling good could mean doing without these medicines, but could equally be because of the continuing use of these medicines. The SSRI users explained that it would be normal to stop at some time in the future. Some tried to stop but did not succeed, because they experienced serious drawbacks, so they continued, although they feared addiction and hoped that they would be able to stop at a later date. Others had never tried to stop, but said that they would like to because it is not normal to stay on this treatment forever. However, they were afraid that they would lose the balance that they had achieved in living a normal life. To support their choice of continuing SSRI use, they presented reasons why, in their case, this continuation was necessary. They all feared or had experiences with drawbacks, and were concerned and uncertain because of contradictory professional and lay messages about stopping the use of antidepressants, especially SSRIs. The fear and uncertainty about stopping without sufficient guidance were stronger than the fear and uncertainty about continuing. Users tended to stay on the safe side: better safe than sorry.

Discussion: The fact that users mentioned their arguments for continuing so explicitly implies that they regarded their SSRI use as problematic and ambivalent. They feared that there would be problems in stopping, and mentioned disagreements on this subject among professionals and in the media. Users saw doctors as important in tackling their fears. Doctors could play an active role in the process of discontinuation, but they have to be aware that as soon as users lose their balance and are unable to live a normal life they will probably decide to continue. Greater agreement on guidelines is needed to support doctors in this matter, when both the patient and the doctor have decided to stop treatment.