• adult psychiatry

With 350 million people affected in the world, depressive disorder is one of the top 20 causes of the overall global burden of disease.1 The high costs, both direct and indirect, of major depressive disorder are largely due to the significant deficits in treatment provision2 and therefore remediable with current therapies. A key international challenge is to determine how best to implement currently available and effective treatments.

There are a number of efficacious pharmacological and non-pharmacological interventions for depressive disorder.3 Antidepressant drugs are recommended and frequently used as first-line therapy for adults with moderate to severe depressive disorder, and in the UK, about 80% of people in primary care receive an antidepressant prescription in the first year of diagnosis.4 However, a significant proportion of these prescriptions are for less than 30 days, while an adequate trial of antidepressants is generally recommended to be 6–8 weeks before changing or stopping the medication.3 A too short duration of treatment limits both the therapeutic effect 5 6 and increases the risk of withdrawal symptoms.

A number of factors contribute to the suboptimal treatment duration of antidepressant drugs, and the two most recognised contributing factors include the …