Psychological medicine

How to choose an antidepressant. A guide for GPs

PHILIP B. MITCHELL

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© kieferpix/istockphoto.com

Abstract

Depression and anxiety are among the most common health presentations to GPs in Australia. Since the 1990s, there has been an increasing range of antidepressants marketed in this country, making it difficult for GPs to decide on the appropriate choice for their patients. This article reviews the current landscape of antidepressants in Australia and details the pros and cons of the various options, drawing on both the published literature and the author’s own clinical experience with mood disorders.

Article Extract

In Australia, mental health conditions such as depression and anxiety continue to be the most common issues managed by GPs.1 GPs prescribe the majority (86%) of antidepressants in this country, with three-quarters of such prescribing initiated in the primary care setting.2 Recent Australian primary care research from the diamond longitudinal study has reported high rates of both under-prescribing (41%) and overprescribing of antidepressants (i.e. for patients without formal depressive or anxiety disorders; 30%).3 This finding of common undertreatment is consistent with an analysis of the 2007 Australian National Survey of Mental Health and Wellbeing.4 According to the analysis, only 39% of those with mood and/or anxiety disorders sought professional help.4 Of those who consulted a health professional, only two-thirds received an evidence-based treatment (such as an antidepressant or appropriate psychological treatment), with only 41% of those consulting receiving minimally adequate treatment (in terms of dose or duration).4

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© kieferpix/istockphoto.com
© kieferpix/istockphoto.com