A Telerehabilitation-Based Fine Motor Training Program for Children With Inattentive Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

Antidepressant medications have substantially improved the health and well-being of many people [], and their success in enabling those experiencing an episode of depression to retain their quality of life has undoubtedly led to their widespread use globally. However, antidepressant use has led to a high and unnecessary economic burden on the health care system and patients through overprescribing. The usual “course length” for antidepressants in an episode of depression is a maximum of 12 months [-], and overprescribing occurs most often when these medications are not appropriately discontinued (termed “legacy prescribing”), when they are no longer clinically necessary, or where they are of no therapeutic use (ie, in the absence of a diagnosed or current indication for use). This represents a real opportunity to improve prescribing. Data indicate that 46% of those who start taking an antidepressant continue taking it for longer than the indicated period, and 61% of those currently prescribed antidepressants fall into this group, with the median length of prescription being 5 years []. Such inappropriate medicine use [,] is not aligned with current clinical guidelines [,] and is a clinical challenge for health care providers globally. The most recent figures from the Organisation for Economic Co-operation and Development show that Australia now has the fourth highest number of users of antidepressants per capita, with the defined daily dose (per 1000 people) increasing nearly 3-fold since 2000 [,], and 87% of these medications are prescribed through general practitioners (GPs) []. This is largely due to an excess of long-term users [,] rather than a higher number of people being newly diagnosed with major depressive disorder (MDD) or other disorders for which antidepressants are prescribed (eg, anxiety) [,]. Several factors drive the inappropriate use of antidepressants. While long-term use of antidepressants is recommended when there is a high risk of suicide, psychosis, or recurrent depression [,], these situations are most often referred to secondary care with a psychiatrist and rarely occur in primary care [,]. A study by our research group showed that in a cohort of 789 primary care patients with depressive symptoms, only 15% of long-term users satisfied the clinical criteria for long-term antidepressant use [,]. There is remarkably little research that explores the long-term effects of antidepressant use, although there are indications that it can be harmful, and as of December 2022, 9 antidepressants are listed on the US Food and Drug Administration watch list for potential signals of serious risk []. Long-term use is often linked to a range of severe side effects, including increased risks of cardiovascular events [], gastrointestinal bleeding [], fractures [], and diabetes []. Psychological dependence is another risk factor, which stems from a user’s perceived need to take antidepressants for fear of a relapse, and that fear, shared by doctors, explains why antidepressant use is often unnecessarily prolonged [,], even though it may undermine patients’ autonomy and resilience, resulting in them becoming less likely to self-manage or willing to stop their antidepressant medication.