Long-term antidepressant use and discontinuation in areas of high multiple deprivation

Background: The volume of antidepressant prescriptions has been increasing, with evidence that 30-50% of users may not need them. Antidepressants can be associated with adverse effects, which can increase with long-term use. Adults living in areas of high multiple deprivation are more likely to be prescribed antidepressants and may face additional challenges to stopping treatment Antidepressants may be less effective in this group. There is evidence that a digital intervention can support patients stopping antidepressants. This may not be appropriate for adults in areas of deprivation, who may need additional support and may experience digital exclusion and literacy barriers. Aims: 1. To explore the views of long-term antidepressant use and discontinuation with adults living in areas of high multiple deprivation. 2. To plan an intervention to support those wishing to discontinue antidepressants. Design: Work package 1 (WP1) comprises a qualitative study using semi-structured and/or asynchronous interviews with people who have taken antidepressants long-term and live in areas of high multiple deprivation. Work package 2 (WP2) comprises the intervention planning phase. Methods: WP1: Up to 25 interviews will explore views of taking, reducing and stopping long-term antidepressants amongst people living in areas of high multiple deprivation. We will employ novel methods to improve how we work with this group (for example asynchronous voice messaging interviews). Data will be analysed using thematic analysis. Work package 2: Findings from WP1 will guide intervention plans to address the needs of this group. This will be done using the Person-Based Approach so that content is grounded in theory, evidence and the perspectives of intended users. This will include Guiding Principles of the intervention, an Intervention Planning Table and a Logic Model. We will design this intervention plan through team meetings, Listening Cafes with the public and through a co-design workshop with primary care practitioners. PPI: This idea was discussed with women from areas of deprivation, with experience taking long-term antidepressants. They identified a need for better support for discontinuing antidepressants and appreciated more flexible participation methods (e.g. using WhatsApp). Our public co-applicant suggested involving local community services for participant recruitment and this was incorporated into the research plan. Public contributors will be involved in designing the research methods, deciding elements of the planned intervention, understanding and interpreting the findings and contribute to all dissemination activities. Dissemination and impact: We will disseminate findings via peer-reviewed publications and conferences and will work with our PPI team to disseminate to a lay audience, including participants. The project will result in an evidence-based and theory-driven plan for an intervention to support people discontinuing antidepressants in the most-deprived regions and will refine recruitment and qualitative methods with this underserved group.