The RELEASE (REdressing Long-tErm Antidepressant uSE in general practice) intervention has been designed to support people to safely stop antidepressants.
Our program of research on antidepressants
This research will improve Australian health outcomes by decreasing unnecessary and potentially harmful long-term (>12 months) use of antidepressants. The outcomes of our research will include a validated antidepressant discontinuation model and proven implementation strategies, including practical resources where currently there are none, to foster sustainable improvement in primary mental health care and improved outcomes for patients.
Australia has one of the highest rates of antidepressant use in the world with around 1 in 7 Australians taking antidepressants, many of them long-term. Most antidepressants are prescribed in general practice (92%). Many people experience unpleasant withdrawal symptoms when they attempt to stop antidepressants. Antidepressant withdrawal symptoms are common and can be severe. Withdrawal symptoms, including feeling anxious and irritable, are readily misconstrued as 'relapse' or ongoing need for medication contributing to long-term use with associated risks and adverse effects.
The RELEASE intervention has been designed to support shared decision-making and provide step-by-step guidance for slow hyperbolic tapering of antidepressant dose to minimise withdrawal symptoms and enable people to safely stop antidepressants.
Aim
Aim 1) Evaluate the RELEASE antidepressant discontinuation model and associated implementation strategies in the Australian general practice context.
Primary objective: Evaluate RELEASE effectiveness compared to usual care.
Secondary objective: Evaluate RELEASE implementation barriers and enablers, acceptability, feasibility and cost-effectiveness.
Aim 2) Support integration of RELEASE into urban, regional and rural general practice nationally.
Design
This is a 3-arm cluster randomised controlled effectiveness-implementation trial in 28 general practices in south-east Queensland.
Principles
RELEASE is a user-informed multi-modal intervention that targets both general practitioners and patients. RELEASE has the following guiding principles:
- All prescribing decisions are made as usual by the GP and patient together.
- Empowering patients.
- Acceptable and translatable in routine general practice.
- Resources developed to raise awareness, prompt medication review, support shared decision-making, and guide safe cessation of long-term antidepressants when there is no clinical indication for continued use.
Recruiting general practices
Practice recruitment has closed.
Patients are only recruited into the study through participating practices.
Timeline
Data collection is expected to be complete by the end of 2025.
Ethical conduct
This study adheres to the Guidelines of the ethical review process of The University of Queensland and the National Statement on Ethical Conduct in Human Research.
The University of Queensland Human Research Ethics Committee approval number: 2022/HE001667.
Whilst you are free to direct questions you may have to our Project Coordinator and Patient Liaison Officer via release.study@uq.edu.au, if you would like to speak to an officer of the University not involved in the study, you may contact the Ethics Coordinators on +617 3365 3924 / +617 3443 1656 or email humanethics@research.uq.edu.au.
Who is funding this research
Medical Research Future Fund (MRFF) 2020 Clinician Researchers: Applied Research in Health - MRFAR000079 (Commonwealth Department of Health).
National Health and Medical Research Council (NHMRC) 2021 Partnership Projects PRC3 – 2015744.
Research leads
Professor Katharine Wallis
Mayne Professor and Head, Mayne Academy of General Practice
Head, General Practice Clinical Unit
Associate Professor Maria Donald
Associate Professor
Research team
Dr Suzanne McDonald
Research Fellow (Health Services Researcher), General Practice Clinical Unit
Sessional Academic, School of Psychology
Karen Thrift
RELEASE GP Liaison Officer
General Practice Clinical Unit
Dr Idin Panahi
RELEASE GP Practice Support Officer
General Practice Clinical Unit
Maryanne Cleetus
RELEASE Senior Research Assistant and Project Coordinator
General Practice Clinical Unit
Mia Slaughter
RELEASE Administration Officer
General Practice Clinical Unit
Polyana Moura Ferreira
RELEASE Post-Doctoral Research Fellow
General Practice Clinical Unit
Collaborating Investigators
Dr Mark Horowitz (Psychiatrist)
Clinical Research Fellow, North East London NHS Foundation Trust; and Honorary
Clinical Research Fellow,
University College London, UK
Professor Joanna Moncrieff (Psychiatrist)
Professor of Critical and Social Psychiatry, University College London, UK;
and Honorary Consultant Psychiatrist,
North East London Foundation NHS Foundation Trust
Professor Rob Ware (Senior Biostatistician)
Menzies Health Institute, Griffith University, Australia
Professor Joshua Byrnes (Senior Health Economist)
Director, Centre for Applied Health Economic, Griffith University, Australia
Associate Investigators
Dr David King
Clinical Senior Lecturer
General Practice Clinical Unit
Related publications
McDonald S, Wallis KA, Horowitz M, et al. Acceptability and optimisation of resources to support antidepressant cessation: A qualitative think-aloud study with patients in Australian primary care. Br J Gen Pract. 2023;74(739):e113. https://bjgp.org/content/74/739/e113
Wallis KA. Many people get withdrawal symptoms when they try to stop antidepressants. So how can you safely stop? The Conversation. 2024. https://theconversation.com/many-people-get-withdrawal-symptoms-when-they-try-to-stop-antidepressants-so-how-can-you-safely-stop-231822
Wallis KA, Donald M, Horowitz M, Moncrieff J, Ware RS, Byrnes J, Thrift K, Cleetus M, Panahi I, Zwar N, Morgan M, Freeman C, Scott I. RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice. Trials. 2023;24(1):615. https://doi.org/10.1186/s13063-023-07646-w
Horowitz M, Moncrieff J, Wallis KA. Antidepressant withdrawal should be taken seriously – we’re investigating ways to help people come off the pills. The Conversation. 2023. https://theconversation.com/antidepressant-withdrawal-should-be-taken-seriously-were-investigating-ways-to-help-people-come-off-the-pills-201101
Wallis KA, Elley CR, Moyes SA, Lee A, Hikaka JF, Kerse NM. Safer prescribing and care for the elderly (SPACE): a cluster randomised controlled trial in general practice. BJGP Open. 2022;6(1). https://pubmed.ncbi.nlm.nih.gov/34645654/
Donald M, Partanen R, Sharman L, Lynch J, Dingle GA, Haslam C, van Driel M. Long-term antidepressant use in general practice: a qualitative study of GPs' views on discontinuation. Br J Gen Pract. 2021;71(708). https://bjgp.org/content/71/708/e508
Dingle GA, Sharman LS, Haslam C, Donald M, Turner C, Partanen R, Lynch J, Draper G, van Driel ML. The effects of social group interventions for depression: systematic review. J Affect Disord. 2021;281:67-81. https://pubmed.ncbi.nlm.nih.gov/33302192/
Wallis KA, Donald M, Moncrieff J. Antidepressant prescribing in general practice: A call to action. Aust J Gen Pract. 2021;50(12):954-956. https://pubmed.ncbi.nlm.nih.gov/34845476/
Wallis KA, Elley CR, Moyes SA, Kerse NM. Safer Prescribing And Care for the Elderly (SPACE): Pilot study in general practice. BJGP Open. 2018;2(3). https://bjgpopen.org/content/6/1/BJGPO.2021.0129
Wallis KA, Tuckey R. Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing. J Prim Health Care. 2017;9(2):145-152. https://pubmed.ncbi.nlm.nih.gov/29530226/
- Wallis KA, Andrews A, Henderson M. Swimming against the tide: Primary care physicians’ views on deprescribing in everyday practice. Ann Fam Med. 2017;15(4):341-346. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505453/
Antidepressants in residential aged care: Exploring the views of residents and their family, facility managers, carers, nurses, GPs and pharmacists
This interview study explored perceptions about the potential benefits and risks of continuing and stopping antidepressants in the residential aged care setting.
Health outcomes associated with long-term antidepressant use: A systematic review
This systematic review is investigating health outcomes associated with long-term use of antidepressants (longer than 12-months).
Implementing the RELEASE intervention in general practice: a case study
This interview study explores the views of patients on long-term antidepressants, GPs and pharmacists about the barriers and enablers to using the RELEASE intervention in practice.