People being treated for moderate depression should all be offered sessions with psychotherapists to help boost their chances of recovery, Australian mental health experts say.
Australians are among the highest users of antidepressants anywhere in the world, but there has been a growing evidence questioning their effectiveness.
Experts from the National Centre of Excellence in Youth Mental Health and the University of Melbourne say while antidepressants have a role to play in treating depression, combining them with psychotherapy is more effective than using either alone.
"All patients should be offered psychotherapy where it is available, and medication should be considered if the depression is of at least moderate severity; psychotherapy is refused; or psychotherapy hasn't been effective," Dr Christopher Davey and Prof Andrew Chanen wrote in the Medical Journal of Australia.
They also recommend doctors encourage patients with depression to eat well and exercise.
Their calls are based on a review of studies examining the effectiveness of antidepressants and psychotherapy for treating adults and children with depression.
Ten per cent of Australian adults take antidepressants each day, with the usage rate having doubled since 2000.
Dr Davey and Prof Chanen said several studies have shown that antidepressants aren't as effective as previously thought, with many suggesting that the "placebo response" can be a key factor as patients taking medication automatically expect they will get well.
Studies looking at psychotherapies, such as cognitive behavioural therapy, have also found a decline in effectiveness.
"The modest effect sizes for depression treatments ... suggest that combining treatments might provide the best outcomes for patients," Dr Davey and Prof Chanen wrote.
"In adults, the effect of combined treatment compared with placebo is about twice that of medication only compared with placebo.
"The effects of psychotherapy and medication appear to operate independently of each other, providing a good rationale for their combination."
