Box 2.

Themes and subthemes

Theme 1: Discontinuation of long-term use of antidepressants is not a simple deprescribing decision
Subtheme	Focus
Assessing patient preparedness	Patients’ life circumstances are as important as recovery from depression in assessing patient preparedness for discontinuation. GPs acknowledged patient relationships with antidepressants that can disrupt preparedness to discontinue.
Subjective and relational decision-making	GPs described decision-making about discontinuation in intuitive and relational terms.
Weighing up benefits and risks	GPs recognised patient empowerment and sense of recovery as potent motivators for ceasing long-term use.
Theme 2: Discontinuation of long-term use of antidepressants is a journey taken together by patient and GP
Subtheme	Focus
Planting the seed for change	GPs valued a process of careful preparation for discontinuation.
Co-designing a personalised plan	A tailored plan of action enables GPs and patients to increase the likelihood of successful discontinuation: a gradual dose reduction plan and proactive relapse plan are considered crucial.
Care continues during and after discontinuation	GPs emphasised regular review and encouragement of social and lifestyle supports during and beyond discontinuation.
Theme 3: Supporting change in GPs’ prescribing practices
Subtheme	Focus
Redressing repeat prescribing as the quick fix	GPs expressed distrust in prescribing norms and felt a need to shift away from ‘set and forget’ attitudes.
Inadequate evidence to support discontinuation	Discussions with patients about discontinuation would be facilitated by better evidence about the harms of long-term use.
Practice-based change	GPs expressed well-communicated ideas about practice level change that would help them discontinue antidepressants.
Solutions beyond general practice	Discontinuation of long-term antidepressant use at the level of the GP–patient alliance will be leveraged by action at the broader system level (for example, social and policy).