Findings from a comprehensive analysis of over 300,000 Pharmaceutical Benefits Scheme (PBS) records reveal a significant rise in long-term antidepressant prescriptions in Australia, with dose-reduction practices lagging behind. This trend raises concerns regarding potential side effects, withdrawal challenges, and increased health-system costs.
New research indicates that Australian antidepressant users are continuing treatment well beyond the recommended durations. The study highlights a notable surge in long-term use across all age demographics, with a particularly sharp increase among younger individuals. This discrepancy underscores a growing divide between clinical guidelines and actual prescribing practices.
Rising Trends in Long-Term Antidepressant Use
Long-term use is defined as taking antidepressants for more than 12 months continuously. In 2014, there were 135,144 long-term antidepressant users in Australia; by 2023, this number had escalated to 199,040, according to researchers from the University of South Australia.
The most significant percentage of long-term users, 76.7%, was found in the 75 years and older age group in 2023. However, the 10 to 24-year age group experienced the largest relative increase, rising from 33.4% in 2014 to 45.1% in 2023, marking a 35% increase.
“Not only are more people taking antidepressants, but once they start, they are staying on them for longer,” said Dr. Lasantha Ranwala, lead author of the study.
Implications of Prolonged Antidepressant Use
The study, published in Pharmacoepidemiology and Drug Safety, analyzed PBS dispensing data from more than 300,000 antidepressant users between 2014 and 2023. The dataset, excluding most medications dispensed to inpatients in public hospitals and private purchases, provided detailed insights into individual usage patterns.
Dr. Ranwala emphasized that while antidepressants are crucial for managing moderate to severe depression, the extended use beyond guidelines can introduce unnecessary risks. He noted that psychological therapies, recommended as first-line treatments for young people, are not being prioritized.
“While antidepressants play a role in managing moderate to severe depression, prolonged use can increase the risk of side effects and make withdrawal more difficult,” Dr. Ranwala explained.
Across the broader population, long-term antidepressant use increased from 66 to nearly 85 users per 1,000 people between 2014 and 2022, with a slight stabilization in 2023. The study also found that women consistently recorded higher usage rates than men throughout the period.
Challenges in Deprescribing Practices
Despite the rise in long-term use, efforts to reduce dosages remain stagnant. Only about 18% of long-term users were on lower doses in both 2014 and 2023, indicating no significant improvement in deprescribing practices.
Professor Libby Roughead, co-author and director of the Quality Use of Medicines and Pharmacy Research Centre, highlighted the lack of routine deprescribing strategies in clinical care. She stressed the urgency of addressing this issue, especially among younger patients.
“Given the increase in long-term use, especially among young people, this is an area that requires urgent attention,” Professor Roughead stated.
The researchers attributed the trend to various factors, including increased psychological distress among young Australians, limited access to psychological therapies, and the lasting mental health impacts of the COVID-19 pandemic.
Call for a Balanced Approach
The study calls for a more balanced approach, advocating for better support for clinicians and patients when tapering medications is appropriate, as well as expanded access to non-pharmacological interventions.
“Australia needs a stronger framework for safely tapering antidepressants, along with better access to psychological care,” Professor Roughead urged.
Associate Professor Andrew Andrade, another co-author, suggested that emerging clinical decision-support technologies could play a crucial role in identifying suitable candidates for deprescribing and providing structured guidance for safe dose reduction.
“Clinicians need stronger support systems to safely deprescribe antidepressants,” said Professor Andrade. “Smart technologies can help identify patients who are good candidates for tapering, coordinate timely access to non-pharmacological treatments, and provide clear, step-by-step guidance to clinicians and patients throughout the slow dose-reduction process.”
The findings underscore the need for a comprehensive strategy to address the growing trend of long-term antidepressant use, balancing therapeutic benefits with potential adverse effects, and ensuring sustainable healthcare practices.
