Researchers from the University of Sydney’s Brain and Mind Centre has just completed an amazing Australian first study. In the process, they made some important discoveries about how well standard antidepressants work for people with atypical depression. The results indicate that at least 1 in 5 Australians suffering from depression do not experience an adequate response to these drugs. This has caused the expert community to re-consider existing clinical practices and treatment protocols.
Among those cut off is 35-year-old Alexis Hutcheon, who has long been treated for extreme atypical depression. Although Ms. Hutcheon received the full gamut of traditional antidepressants, none provided sufficient relief from her debilitating symptoms. Consequently, she was “failing all the time.” After years of trying different treatments, she eventually found a treatment plan that got her back on track. Her experience is indicative of the larger problem with the way atypical depression is being treated in Australia.
The Challenge of Atypical Depression
Atypical depression comes with its own set of challenges and symptoms. Even commonly prescribed SSRIs like sertraline and escitalopram can exacerbate these issues. Ian Hickie, the report’s senior clinical lead, said recruitment was a key problem. Australian clinical guidelines continue to overlook atypical depression, even though the disorder affects 30 – 50 percent of the population.
Why it really matters is twofold. Hickie said that they’re known to not respond well to the treatments that people usually recommend. Further, they are more likely to die from side effects. This situation highlights the critical need for innovation in treatment delivery for this niche, yet serious form of depression.
Mirim Shin, the study’s lead author, added that antidepressants can’t be the only solution for everyone fighting depression. She noticed that patients who had atypical depression were better served by more targeted treatments, treatments that focused on addressing their physical symptoms. “Depression is not a single illness; it’s heterogeneous,” Shin remarked, advocating for more personalized treatment plans that consider individual symptoms and health conditions.
Insights from the Study
The research examined nearly 15,000 Australians with depression, revealing a concerning trend. Many individuals with atypical depression tend to be “night owls,” going to bed late and sleeping longer during the day. This way of life can decrease their access to sunlight, which only makes their condition worse.
Professor Davey said careful consideration should go into how future clinical trials are conducted. He thinks chronotype therapies, which tune treatment to a person’s natural sleep cycle, might excel beyond conventional antidepressants for people with atypical depression. He noted that today’s treatment protocols often overlook these key variables. Attending to them might help generate a more individualized, focused approach to creating mental health.
“We need to educate GPs and clinicians to recognize that depression can be in many forms,” Shin added, stressing the importance of understanding the diverse experiences associated with depression.
The Personal Impact
Alexis Hutcheon’s story is a tragic example of what can happen when patients do not receive the right care at the right time. Reflecting on her journey, she stated, “When you think back, it seems like a really short time—just a year—but when you’re seriously depressed, I’m sure lots of people would agree with me, it feels like forever.”
Ms. Hutcheon was engaged in an all out fight. Every traditional treatment only deepened her sense of despair, as nothing offered her a reprieve. “It feels like you’re constantly failing, that you’ll never get better because I guess these are the standard treatments being advertised—and they’re not working for you,” she lamented.
Her story is a snapshot of the larger problem of misalignment between what patients experience and what providers can do in their clinics. “I think diagnosing and treating depression often relies on broad categories and standard pathways, but not everyone fits neatly into those boxes,” Ms. Hutcheon observed.
Recommendations Moving Forward
Antidepressant consumption has hit record highs in Australia, with an estimated 3.7 million Australians on the drug in 2023-24, reports the Australian Institute of Health and Welfare. In view of this increase, authorities are calling on patients and healthcare providers to reconsider treatment approaches. Professor Hickie advised those who have been on antidepressants for more than eight weeks without improvement to consult their doctors about alternative options.
Chris Davey emphasized the importance of holistic approaches, stating, “Sleep, exercise, diet and alcohol consumption are really important factors, and psychotherapy is really useful… but too often people are only getting medication.”
