It's depression, but is an antidepressant indicated?

15 May 2012

Depression is only second to hypertension as the most common chronic problem seen by Australian GPs. With two thirds of these consultations for depression resulting in a prescription for antidepressants the use of these medicines continues to rise in Australia.

The latest therapeutic program from NPS, Depression: Challenges in primary care encourages GPs to carefully assess the severity of depressive symptoms in patients diagnosed with major depressive disorder and then consider whether an antidepressant is necessary.

NPS clinical adviser Dr Danielle Stowasser says that current guidelines endorse antidepressants for moderate-to-severe major depressive disorder but recommend non-drug therapies as first line for mild depression and in combination with antidepressants for more severe depression.

"When determining if a patient could benefit from taking an antidepressant, a global assessment of the severity of their symptoms should be made, with particular consideration of the degree to which their day to day functioning is impaired and whether they have had suicidal thoughts or intent," says Dr Stowasser.

If an antidepressant is indicated, the patient’s previous experience with antidepressants should be taken into account, along with potential drug interactions and the likelihood of adverse events, such as weight gain, sexual dysfunction and gastrointestinal upset.

"It is particularly important to assess the balance of benefits and harms in older patients, since they experience adverse effects and drug interactions more frequently than younger patients," says Dr Stowasser.

"Also, take the time to explain to patients in detail what they should expect from antidepressant treatment. A medicinewise patient is more likely to adhere to treatment and get the best outcomes."

It is commonly known that between one-third and one-half of patients prescribed an antidepressant discontinue within three months of starting treatment.  Common reasons for this include side effects of antidepressant medicines, lack of understanding about depression as a condition, and what to expect from treatment.

Things to discuss with your patients about antidepressant therapy include:

  • potential side effects
  • how long before the full benefit of treatment is likely to be experienced
  • likely duration of treatment
  • dangers of non-adherence and of stopping treatment abruptly
  • concerns about addiction
  • interactions with over-the-counter medicines such as St John’s Wort and many cough and cold medicines.

Non-drug treatments can be of benefit for people with a depressive disorder regardless of the severity. Physical exercise, cognitive behavioural therapy and interpersonal therapy have been proven to help reduce relapse post-treatment. 

"When deciding on the most suitable non-drug treatment, the patient’s preference should be taken into account to ensure the best chance of success in terms of adherence," says Dr Stowasser.

For more information on depression, and to access the relevant resources for health professionals, visit nps.org.au/depression

ENDS

Independent, evidence-based and not-for-profit, NPS enables better decisions about medicines and medical tests.We are funded by the Australian Government Department of Health and Ageing.