RELEASE: REdressing Long-tErm Antidepressant uSE in general practice

Our antidepressant use study

Background

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.

Australia has one of the highest rates of antidepressant use in the world with around 1 in 7 Australian adults currently taking antidepressants, many of them long-term. Yet clinical guidelines usually recommend only 6 to 12 months therapy for a single episode of major depression and non-pharmaceutical therapy as first line for anxiety and less severe depression. In Australia, most antidepressants are prescribed by general practitioners (92%).

Long-term antidepressant use is not harmless. But people often struggle to stop antidepressants because they experience unpleasant withdrawal symptoms which are commonly misconstrued as impending 'relapse' or ongoing need for medication.

Aim 

The RELEASE study will evaluate effectiveness of the RELEASE and RELEASE+ interventions compared to Usual care. The RELEASE multi-strategy intervention has been designed to prompt medication review, support shared decision-making and guide safe cessation of antidepressants when there is no clinical indication for continued use.

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. 

Vision 

RELEASE seeks to improve Australian health outcomes by decreasing unnecessary and potentially harmful long-term (>12 months) antidepressant use.

Who is conducting this research

The RELEASE research leads are Professor Katharine Wallis and Associate Professor Maria Donald in the General Practice Clinical Unit at The University of Queensland.

Recruiting general practices

We are currently recruiting general practices in southeast Queensland. Please contact us if your practice and GPs would like to participate in the study.

Patients are only recruited into the study through participating practices. 

Contact 

Email: release.study@uq.edu.au

Timeline

Data collection is expected to be complete by the end of 2025.

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

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.

Related Research

 

RELEASE Research Team

Research Leads

Professor Katharine Wallis

Mayne Professor and Head
Mayne Academy of General Practice
Head
General Practice Clinical Unit

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

Tracey Nayler

PhD Student
General Practice Clinical Unit

Collaborating Investigator/s

    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 Investigator/s

Dr David King

Clinical Senior Lecturer
General Practice Clinical Unit