Reasons for Discontinuation or Change of Selective Serotonin Reuptake Inhibitors in Online Drug Reviews

Key Points

Question

What reasons for changes in the use of selective serotonin reuptake inhibitors (SSRIs) are reported on a popular health website?

Findings

This qualitative study of 667 online drug reviews found that the most common reason for discontinuing SSRI use or switching to another SSRI was adverse events experienced, and the most common reason for dose change was titration. Adverse events categorized under psychiatric disorders (mostly apathy, anxiety, insomnia, and loss of libido), investigation results (mostly weight gain), and reproductive system and breast disorders (mostly sexual dysfunction) appeared disproportionately more often in online drug reviews than in US and UK regulatory adverse event reporting data.

Meaning

These results suggest that reasons for changes in SSRI use can be identified in online drug reviews and that adverse events mentioned may reflect those more salient to patients for discontinuing their medication.

Abstract

Importance

Selective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed medication class to treat a variety of mental disorders. However, adherence to SSRIs is low, and uncovering the reasons for discontinuation among SSRI users is an important first step to improving medication persistence.

Objective

To identify the reasons SSRIs are discontinued or changed, as reported by patients and caregivers in online drug reviews.

Design, Setting, and Participants

This qualitative study used natural language processing and machine learning to extract mentions of changes in SSRI intake from 667 drug reviews posted on the online health forum WebMD from September 1, 2007, to August 31, 2021. The type of medication change, including discontinuation, switch to another medication, or dose change and the reason for the change were manually annotated. In each instance in which an adverse event was reported, the event was categorized using Medical Dictionary for Regulatory Activities primary system organ class (SOC) codes, and its relative frequency was compared with that in spontaneous reporting systems maintained by the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency.

Main Outcomes and Measures

Reasons for SSRI medication change as assessed using SOC codes.

Results

In total, 667 reviews posted by 659 patients or caregivers (516 [78%] of patients were female; 410 [62%] 25-54 years of age) were identified that indicated a medication change: 335 posts indicated SSRI discontinuation, 188 posts indicated dose change, and 179 posts indicated switched medications. Most authors 625 (95%) were patients. The most common reason for medication discontinuation or switching was adverse events experienced, and the most common reason for dose change was titration. Both uptitration and downtitration were initiated by either a health care professional or patient. The most common adverse events were classified by SOC codes as psychiatric disorders, including insomnia, loss of libido, and anxiety. Compared with those in regulatory data, psychiatric adverse events, adverse events recorded by investigations (mostly weight gain) and adverse events associated with the reproductive system (mostly erectile dysfunction) were reported disproportionately more often.

Conclusions and Relevance

This qualitative study of online drug reviews found that useful information was provided directly by patients or their caregivers regarding their medication behavior, specifically, information regarding SSRI treatment changes that may inform interventions to improve adherence. These findings suggest that these reported adverse events may be associated with SSRI persistence and that people may feel more inclined to report such events on social media than to clinicians or regulatory agencies.

Abstract

This qualitative study describes the reasons for selective serotonin reuptake inhibitor changes as reported in comments and reviews on the online health forum WebMD by patients and caregivers.