Who bears the costs of antidepressants in Australia?

The authors' analysis fails to reflect the cycle of drug costs normally associated with significant developments in any therapeutic group. Perhaps the most significant fact is the potential increase in the costs of treating depression that will result from better diagnosis and more effective treatment. Difficulty of diagnosis for general practitioners.' concern with side effects and the ever-present possibility of suicide in patients on tricyclics have led to treatment with almost homoeopathic doses. The result has been lower costs and lower effective outcomes, with the hidden costs of depression paid for in the treatment of ancillary physical ailments, hospitalisation and days off work, and so on. Although the newer generation of antidepressants have been listed on the Pharmaceutical Benefits Scheme (PBS), with no greater claims of clinical efficacy, studies show them to be relatively cost effective in community use despite the large differences in PBS prices.v' In fact, Alchin and Tranby have merely recorded the impact on costs of the resounding preference of both doctors and patients for the greater safety and lower side effects of the newer drugs. Despite their cost effectiveness, reversible monoamine oxidase inhibitors and selective serotonin reuptake inhibitors are subject to a prescribing authority which provides only for their use in the " ... treatment of major depressive disorders where other therapy is inappropriate"." The results of the analysis by Alchin and Tranby provide as much a challenge to the PBS expectations of how major depression should be treated as to the burden of cost that these more expensive drugs pose to the health system. Such a challenge has many precedents, including H 2-antagonists and angiotensin-converting enzyme inhibitors. Second generation antidepressants certainly will have long term economic implications, but these are far wider and more positive than will be seen from a narrow focus on relative drug costs.