Study identifies key priorities for research on reducing psychiatric medication

Trinity College DublinNov 12 2024

Study hopes to inform the research agenda and help future research to focus on the questions that are most important to key stakeholders.

The global consumption of psychiatric medication is increasing by 4% annually, with the greatest increase observed in antidepressant use. For people who wish to reduce and/or stop taking medication there are many gaps and unanswered questions on how best to do this. 

Now, a new study led by Trinity College Dublin researchers in the School of Pharmacy & Pharmaceutical Sciences and School of Nursing and Midwifery and driven by key stakeholders representing people with lived experience of taking or stopping psychiatric medication has put forward ten priorities for future research on reducing and stopping psychiatric medicines. The findings are published in the British Medical Journal (Open) [today, Monday 11^thNovember 2024].

According to researchers, these findings will help to guide future research and deliver responsive and strategic allocation of research resources, with a view to improving the future health and well-being of individuals who are prescribed psychiatric medication.

Research based on extensive engagement with key stakeholders 

Researchers wanted to engage with key stakeholders to identify what mattered most to them, representing people with lived experience of taking or stopping psychiatric medication, family members, carers and supporters, and healthcare professionals. This engagement highlighted important uncertainties and gaps in the existing evidence base on this topic that need to be addressed by future research. These priorities are relevant to research funding agencies and could help to guide future research and deliver responsive and strategic allocation of research resources, with a view to improving the future health and well-being of individuals who are taking psychiatric medication.

The research process

A priority-setting partnership (PSP) was conducted using the James Lind Alliance's seven-step process. 

Over 3500 questions were collected from more than 850 respondents worldwide. These responses were analysed and distilled into 32 questions which were subsequently verified as not having been satisfactorily addressed by previous research. These questions were then ranked in a second online survey by over 500 respondents and the findings were discussed in a final prioritisation workshop by 30 stakeholder representatives to produce the final top 10 list of research questions. These questions cover a range of areas including the most effective ways of safely reducing/stopping psychiatric medication and providing support to individuals undergoing the discontinuation process. 

Key findings

1 This study has produced a top 10 list of research priorities on reducing and stopping psychiatric medication through extensive engagement with key stakeholders and addresses an important deficit in current practices of stakeholder engagement as involvement of people with lived experience of mental health challenges in research is not widespread, particularly in the early stages of research priority and agenda setting.

2 The priorities for future research encompass a broad range of issues including: the most effective ways of safely reducing/stopping psychiatric medication and providing support to individuals undergoing the discontinuation process, understanding barriers and enablers to reducing and stopping psychiatric medication, as well as understanding the views and experiences of those who have reduced/stopped these medications or are currently doing so.

3 The findings highlight the value and benefit of using co-production whereby key stakeholders collaborated in a meaningful, inclusive and respectful way to jointly identify priorities.

4 The list highlights important uncertainties and gaps in the existing evidence base on this topic that need to be addressed by future research.

While the researchers anticipated that the data collection process would generate many uncertainties and unanswered questions, they were surprised by the sheer volume and complexity of the uncertainties collected. This is reflected by the fact that several of the questions within the Top 10 list had subparts, and further highlights the pressing need for further research in this area.

Recommendations

The research team recommend that research funders and others responsible for allocation of research funding (including government/policy makers) consider these priorities in terms of guiding future research and delivering responsive and strategic allocation of research resources, with a view to improving the future health and well-being of individuals who are taking psychiatric medication.

Lead author Cathal Cadogan, Associate Professor in Pharmacy Practice at the School of Pharmacy & Pharmaceutical Sciences and Miriam Boland, pharmacist and final year PhD candidate at the School of Pharmacy & Pharmaceutical Sciences said:

 "The findings of this James Lind Alliance priority setting partnership address an important gap by identifying the Top 10 priorities for future research about reducing and stopping psychiatric medicines that were most important to key stakeholders representing people with lived experience of taking or stopping psychiatric medication, family members, carers and supporters, and healthcare professionals. The Top 10 list highlights a broad range of areas that have not been adequately addressed by previous research to date. These include questions around the most effective ways of safely reducing/stopping psychiatric medication and providing support to individuals undergoing the discontinuation process, as well as how to better understand the positive and negative consequences of reducing and stopping psychiatric medication, including withdrawal symptoms. We hope that the publication of these findings will encourage research funders to direct additional funding for research to address the uncertainties that have been identified and ultimately help to improve the health and well-being of people who are taking psychiatric medication."

Agnes Higgins, Professor in Mental Health, School of Nursing and Midwifery and co-author said:

"In the mental health space, for a variety of reasons, people with lived experience of mental health problems, are often excluded from the process of deciding research questions. The methodology used in this study helps to amplify their voices on a topic that is very relevant to their lives and an area where a strong evidence base for practice needs to be developed."