Antidepressant drugs such as serotonin reuptake inhibitors (SSRIs) and tricyclic depressants should be prescribed as the first treatment only in cases of severe depression, says new guidance from the Dutch College of General Practitioners.

It recommends that drug treatment should not be “the first step” for patients exhibiting only “depressive symptoms,” a new category distinct from depression—a move that professional associations believe could substantially reduce the Netherlands’ one million users of antidepressants.

The revised “evidence based professional guidance” recommends that antidepressant treatment should be prescribed from the outset only if the patient’s depression “is accompanied by severe suffering or social dysfunctioning …