Deprescribing of antidepressants: development of indicators of high-risk and overprescribing using the RAND/UCLA Appropriateness Method

作者：Vita Brišnik, Jochen Vukas, Caroline Jung‐Sievers, Karoline Lukaschek, G. Caleb Alexander, Ulrich Thiem, Petra Thürmann, Cornelius Schüle, Sebastian Fischer, Erika Baum, Michael Drey, Sebastian Harder, Wilhelm Niebling, Ulrike Janka, Olaf Krause, Jochen Gensichen, Tobias Dreischulte, for the POKAL-Group, Peter Falkai, Peter Henningsen, Markus Bühner, Helmut Krcmar, Gabriele Pitschel‐Walz, Antonius Schneider, Katharina Biersack, C.U. Brand, Christopher Ebert, Julia Eder, Feyza Gökce, Carolin Haas, Lisa Hattenkofer, Lukas Kaupe, Jonas Raub, Philipp Reindl-Spanner, Hannah Schillok, Petra Schönweger, Clara Teusen, Marie Vogel, Victoria von Schrottenberg, Puya Younesi · 发表于：BMC Medicine · 年份：2024 · DOI：10.1186/s12916-024-03397-w · 被引用次数：21 · 研究领域：Treatment of Major Depression、Mental Health Treatment and Access、Pharmaceutical Practices and Patient Outcomes

BACKGROUND: Antidepressants are first-line medications for many psychiatric disorders. However, their widespread long-term use in some indications (e.g., mild depression and insomnia) is concerning. Particularly in older adults with comorbidities and polypharmacy, who are more susceptible to adverse drug reactions, the risks and benefits of treatment should be regularly reviewed. The aim of this consensus process was to identify explicit criteria of potentially inappropriate antidepressant use (indicators) in order to support primary care clinicians in identifying situations, where deprescribing of antidepressants should be considered. METHODS: We used the RAND/UCLA Appropriateness Method to identify the indicators of high-risk and overprescribing of antidepressants. We combined a structured literature review with a 3-round expert panel, with results discussed in moderated meetings in between rounds. Each of the 282 candidate indicators was scored on a 9-point Likert scale representing the necessity of a critical review of antidepressant continuation (1-3 = not necessary; 4-6 = uncertain; 7-9 = clearly necessary). Experts rated the indicators for the necessity of review, since decisions to deprescribe require considerations of patient risk/benefit balance and preferences. Indicators with a median necessity rating of ≥ 7 without disagreement after 3 rating rounds were accepted. RESULTS: The expert panel comprised 2 general practitioners, 2 clinical pharmacologists, 1 gerontops...