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The unfulfilled promise of the antidepressant medications

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We need more effective treatments for depression, because current treatments avert less than half of the considerable burden caused by the illness.1 Antidepressants are the most commonly used medications, taken by 10% of adult Australians each day, and at a rate that has more than doubled since 2000 to be among the highest in the world.2 Two broad forces have been argued to have driven this trend — in Australia, as in other economically developed countries. First was the broadening of the diagnostic concept of depression with publication of the Diagnostic and statistical manual of mental disorders, third edition (DSM-III) in 1980. Previously, depressive illness was considered to have two subtypes — a “neurotic” illness that responded to psychological therapies and a rarer melancholic depression that had a biological cause and responded to medications. But starting with the DSM-III, the distinction was dropped and the categories were collapsed into the broader “major depressive disorder”. This was followed shortly afterwards by the release of the first selective serotonin reuptake inhibitors (SSRIs) — the short-lived zimelidine in 1982, and then fluoxetine in 1986 — and the ensuing cultural phenomenon that encouraged us to think of depression as resulting from a chemical imbalance that could be corrected with medication. Evidence for depression…