Table 2.
Patients' antidepressant use during the period of the study.
| Trajectory of medication career | Unvoiced agenda (sex) | Longitudinal perspective: was the unvoiced agenda raised later? | GP–patient relationship as defined by GP | Episode or presentation of depression |
|---|---|---|---|---|
| Seeking help | 1. Feelings of ‘weakness’ and being ‘unworthy of GP time’ (M) | Disclosed when returning to a different GP during relapse 6 months after stopping treatment | NP | FP |
| Deciding to start antidepressant | 2. Preference for antidepressants and referral for counselling (F) | Disclosed at second appointment, with a different GP | K | NE |
| 3. Preference for antidepressants (F) | Antidepressant prescribed in the same consultation as non-disclosure | K | NE | |
| 4. Ambiguity over diagnosis and treatment with antidepressants (F) | Undisclosed; patient remained confused for 5 months before deciding to start antidepressant | K | NE | |
| 5. Preference for a counselling referral (F) | Undisclosed for 6 months after being prescribed antidepressant, and 1 month after treatment began | K | NE | |
| 6. Preference for antidepressants (M) | Undisclosed; antidepressants prescribed in same consultation | NP | FP | |
| Fear of addiction (F) | Undisclosed; antidepressants prescribed, patient started treatment but did not return to GP, discontinued treatment | NP | FE | |
| 8. Fears long recovery process (F) | Undisclosed, decided not to take antidepressants for length of study | NP | FE | |
| 9. Ambiguity over diagnosis and treatment with antidepressants (M) | Disclosed in follow-up consultation | NP | FP | |
| 10. Symptom of sleeplessness (F) | 10. Undisclosed | NP | FE | |
| Dosage | No unvoiced agendas | |||
| Type of antidepressant | No unvoiced agendas | |||
| Next appointment interval | 11. Not wanting to meet so regularly (F) | Disclosed in subsequent consultations. | K | NE |
| Reviewing dosage (increase) | 12. Preference to increase dosage (F) | Later disclosed after three consultations | K | NE |
| Deciding to continue antidepressant treatment | 13. Worsening of suicidal thoughts (M) | Disclosed 6 months later after stopping treatment and having severe relapse | NP | FP |
| 14. Ambivalence about treatment effect (M) | Undisclosed | NP | FP | |
| 15. Does not share disappointment ‘it is not a cure’ (M) | Undisclosed | NP | FP | |
| 16. Return of suicidal thoughts (F) | Undisclosed | K | NE | |
| 17.Regular experience of panic attacks (F) | Undisclosed | NP | FE | |
| Counselling | 18. Reluctance to pursue counselling not disclosed (F) | Undisclosed | NP | NE |
| Exercise | No unvoiced agendas | |||
| Deciding to stop | 19. Loss of libido as one factor in wanting to stop treatment (F) | Undisclosed | K | NE |
| 20. Interest in continuing treatment (M) | Undisclosed | NP | FP | |
| Reducing dosage as part of stopping | 21. Does not share worry about relapse (M) | Undisclosed, patient takes dose erratically on ‘bad days’ | NP | FP |
| 22. Should we have tried another antidepressant? (M) | Undisclosed | NP | FP | |
| 23. Should we pursue another type of treatment? (M) | Undisclosed | NP | FP | |
F = female. FE = first episode. FP = first presentation. K = known. M = Male. NE = new episode. NP = new patient. WK = well-known.