The unfulfilled promise of the antidepressant medications

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.