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  • Q&A with Australian Health Practitioners

    Are anti-depressants overprescribed today?

    Related Topics
    Depression Mental Health
    Is the rate of depression increasing? I estimate that about half of my female friends are on anti-depressants these days. I'm worried that perhaps it was an “easy way out” and that they should be more cautious when taking these. Can you please provide your opinion and any concerns regarding this area.
    • 2 answers
    • Dr Simon Easterbrook-Smith
    • Anthony Berrick
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  • Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    *Important disclaimer*
    I am not a mental health professional.

    From my personal experience plus a fair bit of reading I think there is good evidence that people with mild-moderate depression can recover well with talk therapy (from a clinical psychologist) without need for ADs.

    However, for people (like me) who are in remission from severe depression, ADs are often needed.

    I would be very reluctant to accept a prescription for an AD from a GP unless I *knew* that s/he has a strong track record of working with clients with mental health issues (the beyondblue Web site, http://www.beyondblue.org.au/index.aspx? , has a list of such people).

    My preference would be to use a GP to give me referrals to a mental health care team (ideally *both* a clinical psychologist and a psychiatrist) so they can do a *proper* assessment and then, based on that, discuss the option of ADs with me.


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    Thanks

    Anthony Berrick

    Psychologist

    Considering that kiwi33 isn't a mental health professional, he/she has given a very good answer!

    There was a famous study conducted in 2008 (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045) in which the researchers used Freedom of Information to access unpublished drug company data from clinical trials of 4 of the most commonly prescribed antidepressants (Aropax, Effexor, Prozac, Serzone). When they combined this unpublished data with the published data, they found that the anti-depressants were no better than a placebo (a sugar-pill) in alleviating depression for moderately and severely depressed patients. They did find that the antidepressants were slightly better than a placebo for extremely severely depressed patients but this difference was not clinically significant (i.e. it was such a small difference that it was practically meaningless for clinical practice).

    The results of this study - which remains the most comprehensive study of these antidepressants ever conducted - suggest that these drugs should only be prescribed to patients with extremely severe depression, in conjunction with psychological therapy.  

    Other antidepressants, such as sertraline (Zoloft), appear to be reasonably effective based on results of numerous clinical studies. However, there are other interventions, such as psychological therapy and even physical exercise, that have been shown to be at least as effective as antidepressants but don't carry the risks that medication does.

    If antidepressants were as harmless as asprin or panadol, then there wouldn't really be an issue with prescribing them to patients who don't really need them. But unfortunately, antidepressants are psychoactive drugs with lots of undesirable side-effects and somewhat uncertain long-term consequences, so it is important that they are only used when really needed.

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