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The unfulfilled promise of the antidepressant medications

Christopher G Davey and Andrew M Chanen
Med J Aust 2016; 204 (9): 348-350. || doi: 10.5694/mja16.00194

Summary

  • Australia has one of the highest rates of antidepressant use in the world; it has more than doubled since 2000, despite evidence showing that the effectiveness of these medications is lower than previously thought.
  • An increasing placebo response rate is a key reason for falling effectiveness, with the gap between response to medications and placebo narrowing.
  • Psychotherapies are effective treatments, but recent evidence from high-quality studies suggests that their effectiveness is also modest.
  • Combined treatment with medication and psychotherapy provides greater effectiveness than either alone.
  • The number of patients receiving psychotherapy had been declining, although this trend is probably reversing with the Medicare Better Access to Mental Health Care initiative.
  • Antidepressant medications still have an important role in the treatment of moderate to severe depression; they should be provided as part of an overall treatment plan that includes psychotherapy and lifestyle strategies to improve diet and increase exercise.
  • When medications are prescribed, they should be used in a way that maximises their chance of effectiveness.

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  • Christopher G Davey1,2
  • Andrew M Chanen1,2

  • 1 Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
  • 2 University of Melbourne, Melbourne, VIC

Correspondence: c.davey@unimelb.edu.au

Competing interests:

No relevant disclosures.

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