Supplementary Material of: Barriers and Facilitators to Antidepressant Deprescribing in German General Practices - A Qualitative Interview Study

<b>Abstract</b><b>Background</b>Long-term use of antidepressants frequently extends beyond clinical guidelines, with limited structured support for deprescribing in primary care. Little is known about the factors that influence general practitioners (GPs) in Germany regarding deprescribing of antidepressants.<b>Objectives</b>· To identify barriers and facilitators that influence GPs in Germany regarding antidepressant deprescribing.· To provide points of departure for developing a targeted intervention to address these challenges.<b>Methods</b>We conducted semi-structured interviews with 20 GPs in Bavaria and purposively sampled for diversity in gender and professional experience. The interview topic guide was informed by the Capability-Opportunity-Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Interviews were transcribed verbatim. Thematic analysis was conducted using a structured coding approach.<b>Results</b>Key barriers to deprescribing included time constraints, limited practical tools, and inadequate collaboration with specialists, as well as uncertainty about when to deprescribe. Social and psychological factors, such as patient fears, were also significant. Facilitators included strong GP-patient communication, the use of digital tools, pharmacist support, and positive attitudes toward deprescribing.<b>Conclusion</b>Antidepressant deprescribing in German primary care is shaped by systemic, social, and behavioural factors. Addressing time constraints, enhancing interdisciplinary collaboration, and integrating decision-support tools into clinical practice could facilitate deprescribing. These insights inform targeted interventions to promote safe and evidence-based antidepressant use. Further research is recommended to develop an intervention suitable for real-world usage.

<b>摘要</b>
<b>背景</b>抗抑郁药的长期使用时常超出临床指南范畴，且初级保健领域针对抗抑郁药减停（deprescribing）的结构化支持措施极为有限。目前学界对德国全科医生（General Practitioners，GPs）开展抗抑郁药减停的影响因素仍知之甚少。
<b>目标</b>· 明确影响德国GPs开展抗抑郁药减停的阻碍因素与促进因素；· 为针对上述挑战制定针对性干预措施提供切入点。
<b>方法</b>本研究对巴伐利亚州的20名GPs开展半结构化访谈，并基于性别与从业经验的多样性进行目的性抽样。访谈提纲以能力-机会-动机-行为（Capability-Opportunity-Motivation-Behaviour，COM-B）模型与理论领域框架（Theoretical Domains Framework，TDF）为依据。访谈内容均进行逐字转录，随后采用结构化编码方法开展主题分析。
<b>结果</b>抗抑郁药减停的主要阻碍因素包括时间紧张、实用工具匮乏、与专科医生协作不足，以及对抗抑郁药减停时机的不确定性。社会与心理因素（如患者的担忧）同样影响显著。促进因素则包括良好的医患沟通、数字化工具的使用、药剂师的支持，以及对抗抑郁药减停的积极态度。
<b>结论</b>德国初级保健中的抗抑郁药减停工作受系统性、社会性与行为性因素共同影响。通过缓解时间压力、加强跨学科协作，以及将决策支持工具融入临床实践，可有效推动抗抑郁药的减停工作。本研究结论可为制定旨在促进安全且基于证据的抗抑郁药使用的针对性干预措施提供参考。建议未来开展进一步研究，以开发适用于真实临床场景的干预方案。