Psychiatry

What to do When SSRI and SNRI Antidepressants don’t Work: A Guide for GPs

Depression is the most common mental health related presentation in general practice, but only a third of patients achieve remission with first line selective serotonin reuptake inhibitors (SSRIs), and many experience significant adverse effects. When SSRIs and serotonin-noradrenaline reuptake inhibitors (SNRIs) fail or cause intolerable side effects, GPs can switch to other antidepressants within the same class or between different classes. GPs can also increase doses, combine medications or augment treatment with antipsychotics. Although all antidepressants are more effective than placebo, their efficacy and tolerability differ. Consider referring patients for specialist review if treatment failure persists despite trialling other options.

Modern Medicine – Issue 2, 2025

Anxiety Disorders are Notoriously Undertreated

Anxiety disorders are the most prevalent psychiatric disorders and are associated with a high burden of illness. With a 12-month prevalence of 10.3%, specific (isolated) phobias are the most common anxiety disorders, although persons suffering from isolated phobias rarely seek treatment. Panic disorder with or without agoraphobia is the next most common type with a prevalence of 6.0%, followed by social anxiety disorder (also called social phobia; 2.7%) and generalised anxiety disorder (GAD; 2.2%). Alprazolam is the most commonly prescribed psychotropic medication for anxiety and panic disorders in the US.

Modern Medicine – Issue 4 2024

Managing Depression: Using a clinical practice guideline approach

The 2020 update of the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders provides a new framework for managing depressive disorders that moves beyond the stepped care approach. This framework is based around three key components: actions, such as lifestyle modification and patient education; choices in pharmacological treatment that include the patient’s preferences; and potential alternative treatments.

Modern Medicine – Issue 2 2023

Managing Major Depressive Disorder

Major depressive disorder (MDD) or Major Affective Disorder is a severe psychiatric disorder affecting over 200 million people worldwide. The lifetime depression risk is 15–18% and is higher in women than men.1 Aetiologically, while societal and environmental factors play a significant role in the psychosocial development of depression, underlying biological and genetic factors are also key drivers, and the two interact via epigenetic mechanisms.

Modern Medicine – Issue 1 2022

Clinical Practice Guidelines for the Assessment and Management of ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. ADHD affects around 5 % – 7 % of school-aged children. It is a neurodevelopmental disorder that runs a chronic course and causes significant impairments across various domains of everyday functioning, such as peer and social functioning, academic functioning and occupational functioning across the lifespan. Besides the patient, ADHD also has significant negative impact on the caregivers. This is a shortened version of the original article.

Modern Medicine – Issue 4 2021