Medical Journal of Australia最新文献

{"title":"Severe hypoglycaemia secondary to chronic opioid-induced hypothalamic–pituitary–adrenal axis suppression: an under-recognised phenomenon","authors":"Michael Do, Annabelle G Hayes, Malgorzata M Brzozowska","doi":"10.5694/mja2.52647","DOIUrl":"10.5694/mja2.52647","url":null,"abstract":"<p>A 49-year-old woman with type 2 diabetes mellitus was hospitalised with critical hypoglycaemia (blood glucose level, 0.9 mmol/L; reference interval [RI], 3.5–5.4 mmol/L). The hypoglycaemia was initially attributed to reduced oral intake and her insulin regimen (NovoMix 30, 40 units twice daily). However, persistent hypoglycaemic episodes, despite insulin discontinuation, required intravenous dextrose boluses over a 12-hour period. Comorbidities included obesity (body mass index, 30.4 kg/m<sup>2</sup>), hypertension and migraines managed with codeine and oxycodone at a dose equivalent to 80 mg of oral morphine per day. This raised suspicion of opioid-induced central adrenal insufficiency (OIAI). She denied weight loss and nausea; however, reported significant lethargy.</p><p>The diagnosis of OIAI was supported by a critically low morning serum cortisol level (9 nmol/L; RI, 155–599 nmol/L), and an adrenocorticotropic hormone (ACTH) level less than 1 ng/L (RI, 7.2–63.3 ng/L). Thyroid function was normal (thyroid-stimulating hormone, 3.5 mIU/L; RI, 0.27–4.2 mIU/L; free thyroxine, 13.1 pmol/L; RI, 12.0–22.0 pmol/L) with suppressed gonadotrophins. The patient was taking the combined oral contraceptive pill (OCP). A magnetic resonance imaging scan of the pituitary showed normal anatomy, with no sellar mass or radiological signs of hypophysitis.</p><p>The patient was commenced on hydrocortisone (20 mg morning, 4 mg midday, 4 mg evening) and was counselled on sick day management. Insulin doses (NovoMix 30) were reduced to 32 units twice daily and the OCP was no longer given. Neurologist-led efforts to reduce the patient's opioid intake were unsuccessful due to poor response to alternative migraine treatments. Her lethargy improved and no further hypoglycaemic episodes occurred. Low ACTH levels with peak cortisol levels of 200 nmol/L (RI, > 450 nmol/L) on cosyntropin stimulation tests (CSTs) conducted at the one-year and six-year marks confirmed unresolved chronic OIAI, warranting indefinite hydrocortisone therapy.</p><p>Hypoglycaemia in type 2 diabetes mellitus is typically attributed to antidiabetic medications; however, the diagnosis of adrenal insufficiency, although rare, should be considered in severe or prolonged hypoglycaemia.<span><sup>1</sup></span> The clinical manifestations of adrenal insufficiency can be non-specific and resemble those caused by opioid therapy and the underlying conditions requiring opioid treatment. Other causes of adrenal insufficiency such as space-occupying lesions, pituitary apoplexy, head trauma and drug-induced adrenal insufficiency, including exogenous steroids, were absent in the patient and should be excluded.<span><sup>2</sup></span> Notably, the patient's serum cortisol level was strikingly low despite OCP use, which elevates total cortisol concentrations by increasing corticosteroid-binding globulin.<span><sup>3</sup></span></p><p>Chronic opioid use is widespread in Australia, with 3.1 million Australians p","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 9","pages":"434-435"},"PeriodicalIF":6.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52647","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing Australia for future pandemics: strengthening trust, social capital and resilience","authors":"Shanti Narayanasamy, Alisa Pedrana, Katherine B Gibney, Lisa Gibbs, Margaret E Hellard","doi":"10.5694/mja2.52652","DOIUrl":"10.5694/mja2.52652","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 10","pages":"488-492"},"PeriodicalIF":6.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beware of the rinse: magic mouthwash as a rare cause of iatrogenic Cushing syndrome and secondary adrenal insufficiency","authors":"Mark Schifter, Suma Sukumar","doi":"10.5694/mja2.52651","DOIUrl":"10.5694/mja2.52651","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 10","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should self-administered voluntary assisted dying be supervised? A Queensland case","authors":"Eliana Close, Katrine Del Villar, Ben P White","doi":"10.5694/mja2.52634","DOIUrl":"https://doi.org/10.5694/mja2.52634","url":null,"abstract":"<p>All Australian states and the Australian Capital Territory have voluntary assisted dying (VAD) laws. Medication management will be topical in these laws’ mandatory reviews following a Queensland coronial inquest into the death of a person who consumed a VAD substance prescribed for their spouse. In a decision issued on 11 September 2024, the coroner found “operational flaws” in Queensland's VAD law, declaring current self-administration procedures “inadequate to provide for medication safety and to prevent deliberate misuse”.<span><sup>1</sup></span> These findings have nationwide relevance as all Australian VAD laws permit eligible persons to self-administer without a health practitioner present.<span><sup>2</sup></span></p><p>On 16 May 2023, ABC (pseudonym), an older person, died after purposely consuming a VAD substance prescribed for their terminally ill spouse.<span><sup>1</sup></span> Due to the sensitive nature of the case, the coroner's report includes a ban on publishing identifying details. Accordingly, ABC, their spouse (the terminally ill patient), and adult child are referred to using neutral terms.</p><p>The circumstances leading to ABC's death are set out in Box 1.</p><p>The coroner recommended that self-administration should be supervised by a health practitioner, an option that was considered by the Queensland Law Reform Commission (prompted by a proposed VAD bill)<span><sup>4</sup></span> but was not adopted.<span><sup>5</sup></span></p><p>The coroner warned of “[f]urther calamity and heartbreak” for patients and families without system reform.<span><sup>1</sup></span> He specifically confined his critical remarks to the system rather than the individuals working within it, noting that QVAD-SPS personnel had not breached the law or any protocol.</p><p>The Australian model of VAD is characterised by narrow eligibility criteria and numerous safeguards.<span><sup>2</sup></span> One of these safeguards is that only medical practitioners (and in some states, nurses or nurse practitioners) who complete mandatory training and meet additional experience and expertise requirements can participate in key aspects of VAD (“VAD practitioners”). Two independent VAD practitioners assess whether a person is eligible for VAD (in the states, only medical practitioners can do VAD assessments; but in the ACT, one practitioner can be a nurse practitioner). If the person is eligible, the lead VAD practitioner (“coordinating practitioner”) writes the prescription for the VAD substance.</p><p>Australian VAD medication protocols are not publicly available but, as in other countries, the VAD substance is a combination of medications used in health care settings (including a Schedule 8 [S8] medicine).<span><sup>3, 6</sup></span> The medication protocol differs depending on the method of administration. Self-administration involves mixing a liquid that a person drinks (or ingests via nasogastric tube), while practitioner administration typically involve","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 8","pages":"390-393"},"PeriodicalIF":6.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current gaps in knowledge and future research directions for Aboriginal and Torres Strait Islander children with cancer","authors":"Alexandra Truong,&nbsp;Kayla Williams-Tucker (Ngarluma, Wongutha, Wudjari Noongar),&nbsp;Ahmi Narkle (Whadjuk Goreng Noongar),&nbsp;Eden Slicer (Gundungurra),&nbsp;Jessica-Elise Chapman (Kamilaroi, Bundjalung),&nbsp;Jessica Lawler,&nbsp;Rishi S Kotecha,&nbsp;Hetal Dholaria,&nbsp;Justine R Clark (Adnyamathanha),&nbsp;Alex Brown (Yuin),&nbsp;Raelene Endersby,&nbsp;Nicholas G Gottardo,&nbsp;Jessica Buck (Kamilaroi)","doi":"10.5694/mja2.52650","DOIUrl":"10.5694/mja2.52650","url":null,"abstract":"<p>\u0000 \u0000 </p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 10","pages":"524-528"},"PeriodicalIF":6.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I am a Civil War","authors":"Jennifer G Mowbray","doi":"10.5694/mja2.52646","DOIUrl":"10.5694/mja2.52646","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 9","pages":"436-437"},"PeriodicalIF":6.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of health and intensive care unit admission rates and outcomes for children, Australia, 2013–2020: analysis of national registry data","authors":"Katie M Moynihan,&nbsp;Vanessa Russ,&nbsp;Darren Clinch,&nbsp;Lahn Straney,&nbsp;Johnny Millar,&nbsp;Marino Festa,&nbsp;Natasha Nassar,&nbsp;Shreerupa Basu,&nbsp;Thavani Thavarajasingam,&nbsp;Debbie Long,&nbsp;Paul J Secombe,&nbsp;Anthony J Slater,&nbsp;the Australian and New Zealand Intensive Care Society Paediatric Study Group and Centre for Outcomes and Resource Evaluation","doi":"10.5694/mja2.52643","DOIUrl":"10.5694/mja2.52643","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To investigate the influence of non-medical social determinants of health on rates of admission and outcomes for children admitted to intensive care units (ICUs) in Australia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective cohort study; analysis of Australian and New Zealand Paediatric Intensive Care Registry data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting, participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Children (18 years or younger) admitted to Australian ICUs during 1 January 2013 – 31 December 2020.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main outcome measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Population-standardised ICU admission rates, overall and by residential socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD] quintile) and Indigenous status; likelihood of mortality in the ICU by residential socio-economic status (continuous, and quintile 1 &lt;i&gt;v&lt;/i&gt; quintiles 2–5) and Indigenous status, adjusted for pre-illness, admission, and ICU and hospital factors.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data for 77 233 ICU admissions of children were available. The ICU admission rate for Indigenous children was 1.91 (95% confidence interval [CI], 1.87–1.94), for non-Indigenous children 1.60 (95% CI, 1.57–1.64) per 1000 children per year. The rate was higher for children living in areas in the lowest IRSD quintile (1.93; [95% CI, 1.89–1.96]) than for those living in quintile 5 (1.26 [95% CI, 1.23–1.29] per 1000 children per year). Unadjusted in-ICU mortality was higher for Indigenous than non-Indigenous children (2.5% &lt;i&gt;v&lt;/i&gt; 2.1%) and also for children living in the lowest IRSD quintile than in quintiles 2–5 (2.5% &lt;i&gt;v&lt;/i&gt; 2.0%). After adjustment for all factors, mortality among Indigenous children was similar to that for non-Indigenous children (adjusted odds ratio [aOR], 1.15; 95% CI, 0.92–1.43); it was higher for children living in the lowest IRSD quintile than for those living in quintiles 2–5 (aOR, 1.18; 95% CI, 1.03–1.36). Remoteness and distance between home and ICU did not influence the likelihood of death in the ICU.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The population-standardised ICU admission rate is higher for Indigenous children and children residing in areas of greatest socio-economic disadvantage than for other children in Australia. Adjusted in-ICU mortality was higher for children from areas of great","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 8","pages":"412-421"},"PeriodicalIF":6.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accountability frameworks for climate change and health: research is leading the way","authors":"Virginia Barbour","doi":"10.5694/mja2.52633","DOIUrl":"https://doi.org/10.5694/mja2.52633","url":null,"abstract":"&lt;p&gt;As I am writing this Editor's Choice, I am in the process of preparing our house in Queensland for a cyclone, predicted to hit Brisbane in about 48 hours. The cover topic of this month's issue of the &lt;i&gt;MJA&lt;/i&gt; is therefore very much at the front of my mind.&lt;/p&gt;&lt;p&gt;This issue contains the seventh report of the &lt;i&gt;MJA–Lancet&lt;/i&gt; Countdown on health and climate change, which examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement (https://doi.org/10.5694/mja2.52616). The analyses by Beggs and colleagues have some unsurprising but still concerning findings: the exposure to heatwaves in Australia is growing, which in turn increases the risk of heat stress; other health threats such as bushfires and drought — “features of the continent for millennia” — are amplified by climate change. Cyclones, as we are currently facing, are noted as major causes of economic losses. This year, the authors also report against a new indicator: climate litigation over the past decade. The findings are instructive: one case is “a legally significant acceptance, by government, of the science concerning the health impacts of climate change”. However, litigation is just one driver of change. As the authors note: “Nationally, regionally and globally, the next five years are pivotal in reducing greenhouse gas emissions and transitioning energy production to renewables. Australia is now making progress in this direction. This progress must continue and accelerate, and the remaining deficiencies in Australia's response to the health and climate change threat must be addressed”.&lt;/p&gt;&lt;p&gt;Another perspective in this issue of the &lt;i&gt;MJA&lt;/i&gt; discusses the importance of Australia endorsing a fossil fuel non-proliferation treaty (https://doi.org/10.5694/mja2.52610). Colagiuri and colleagues outline the aims of the Fossil Fuel Non-Proliferation Treaty and why it is relevant to health. Starkly put, we are not on track to meet the goals of the Paris Agreement — and as events in the United States unfold, it seems as if political will is shifting even further away from support for the agreement. The authors argue that the Fossil Fuel Non-Proliferation Treaty is a way to directly address the key driver of the climate crisis. It has not been signed by Australia, perhaps unsurprisingly, though eleven Pacific nations, which well understand the risk, have signed on. Endorsing the Fossil Fuel Non-Proliferation Treaty would, the authors argue, be “more than just a climate strategy for Australia; it represents a vital step towards advancing global health justice and fostering regional solidarity”.&lt;/p&gt;&lt;p&gt;How pharmaceutical companies are progressing in their carbon emission plans is assessed in a research article by Burch and colleagues (https://doi.org/10.5694/mja2.52621). Drawing on publicly available documents on actions during 2015–2023","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"271"},"PeriodicalIF":6.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2024 report of the MJA–Lancet Countdown on health and climate change: Australia emerging as a hotspot for litigation","authors":"Paul J Beggs,&nbsp;Alistair J Woodward,&nbsp;Stefan Trueck,&nbsp;Martina K Linnenluecke,&nbsp;Hilary Bambrick,&nbsp;Anthony G Capon,&nbsp;Zerina Lokmic-Tomkins,&nbsp;Jacqueline Peel,&nbsp;Kathryn Bowen,&nbsp;Ivan C Hanigan,&nbsp;Nicolas Borchers Arriagada,&nbsp;Troy J Cross,&nbsp;Sharon Friel,&nbsp;Donna Green,&nbsp;Maddie Heenan,&nbsp;Ollie Jay,&nbsp;Harry Kennard,&nbsp;Arunima Malik,&nbsp;Celia McMichael,&nbsp;Mark Stevenson,&nbsp;Sotiris Vardoulakis,&nbsp;Aditya Vyas,&nbsp;Marina B Romanello,&nbsp;Maria Walawender,&nbsp;Ying Zhang","doi":"10.5694/mja2.52616","DOIUrl":"https://doi.org/10.5694/mja2.52616","url":null,"abstract":"<p>\u0000 \u0000 </p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 6","pages":"272-296"},"PeriodicalIF":6.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant prescribing in Australian primary care: time to reevaluate","authors":"Katharine A Wallis,&nbsp;Anna King,&nbsp;Joanna Moncrieff","doi":"10.5694/mja2.52645","DOIUrl":"10.5694/mja2.52645","url":null,"abstract":"&lt;p&gt;Around one in seven Australians is now taking antidepressants (3.9 million people, 14%),&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and the prevalence of use is rising.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Two antidepressants, sertraline and escitalopram, are now in the top ten drugs by defined daily dose per 1000 population per day.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In Australia, women are prescribed antidepressants at 1.5 times the rate of men, and older people (aged ≥ 65 years) are twice as likely to be prescribed antidepressants as younger people (aged &lt; 65 years).&lt;span&gt;&lt;sup&gt;2, 5&lt;/sup&gt;&lt;/span&gt; Around 26% of people aged 75 years or older are taking antidepressants.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Most psychological distress or mental illness is managed in primary care, and antidepressant prescribing is overwhelmingly in primary care, with general practitioners prescribing 92% of antidepressants in Australia.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The explanation for higher antidepressant prescribing in women and older people remains uncertain. Social issues such as loneliness, grief or abuse are not resolved by antidepressants. Leading psychiatrists argue that we cannot exclude the rising prevalence of depression or “better recognition (by both patients and clinicians) and treatment of depression in primary care” as explaining the increase in antidepressant use.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Yet, there is evidence from primary care that people are prescribed antidepressants when clinical guideline criteria are not met, more commonly women.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Further, it is unlikely that 14% of the Australian population would fit the clinical guideline criteria for antidepressant use. Clinical guidelines recommend non-drug interventions as first line for anxiety and less severe depression, and “in severe major depression” antidepressant therapy for “6 to 12 months, then consider deprescribing”.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; It is widely accepted that antidepressant effects “may be minimal or non-existent, on average, in patients with mild or moderate symptoms”.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; A recent systematic review and network meta-analysis “found some forms of exercise to have stronger effects than [selective serotonin reuptake inhibitors] alone”.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; Debate about antidepressants and suicide is ongoing, but the United States Food and Drug Administration has long directed manufacturers to include a boxed warning for increased suicide risk with antidepressants in younger people.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Regardless of whether initiation was justified or not, evidence suggests that the increase in antidepressant use is due largely to rising long term use (longer than 12 months); that is, people failing to stop antidepressants.&lt;span&gt;&lt;sup&gt;12, 13&lt;/sup&gt;&lt;/span&gt; Around half of people taking antidepressants take them for longer than two years.&lt;span&gt;&lt;sup&gt;14&lt;/sup&gt;&lt;/span&gt; In the ongoing RELEASE (Redressing Long-Term Antidepressant Use) trial in 26 general practice clinics in south","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 9","pages":"430-432"},"PeriodicalIF":6.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52645","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}