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Difficult-to-treat depression

This is a republished version of an article previously published in MJA Open

What can GPs do when a patient with depression does not get better?

Depression remains a leading cause of distress and disability worldwide. In the 1997 Australian National Survey of Health and Wellbeing, 7.2% of people surveyed had experienced a mood (affective) disorder in the previous 12 months.1 Those affected reported a mean of 11.7 disability days (when they were “completely unable to carry out or had to cut down on their usual activities owing to their health”) in the previous 4 weeks. There was also evidence of substantial undertreatment: only 35% of people with a mental health problem had a mental health consultation during the previous 12 months. Of those with a mental health problem, 27% (ie, three-quarters of those seeking help) saw a general practitioner. In the 2007–08 Australian National Health Survey, not much had changed: 12-month prevalence rates were 4.1% for depression, 1.3% for dysthymia and 1.8% for bipolar disorder.2 These disorders were associated with significant disability, role impairment, and mental health and substance use comorbidity.…