A concerning trend is unfolding in Australia: long-term antidepressant use is on the rise, sparking alarms about potential over-prescription. This is especially true for young people, with rates more than doubling in the 10-24 age group. Let's delve into what this means and why it matters.
This information comes from a comprehensive study conducted by researchers at the University of South Australia, analyzing data from the Pharmaceutical Benefits Scheme (PBS). They examined the records of over 300,000 antidepressant users between 2014 and 2023. The findings, published in the Pharmacoepidemiology and Drug Safety Journal, are quite revealing.
The study found that a significant portion of young people, 45%, are staying on antidepressants for over 12 months, and a considerable number continue using them even after two years. Long-term use, defined as continuous use for more than 12 months, has increased across all age groups, but the surge is most pronounced among young Australians.
Dr. Lasantha Ranwala, the lead author of the study, highlights a critical shift in how antidepressants are being used. This raises concerns about potential over-prescription and a deviation from guidelines that recommend a careful review of medication use after 6-12 months. "Not only are more people taking antidepressants, but once they start, they are staying on them for longer," Dr. Ranwala states. This is particularly concerning for younger individuals, where clinical guidelines often suggest psychological therapies as the initial treatment approach.
Across the entire population, long-term antidepressant use increased from 66 to nearly 85 users per 1000 people between 2014 and 2022, before slightly stabilizing in 2023. Notably, women consistently showed higher usage rates than men throughout the study period.
Dr. Ranwala also points out the potential risks associated with prolonged use. "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." Withdrawal symptoms can often be misinterpreted as a return of the underlying condition, which can further extend treatment, exacerbating the problem.
But here's where it gets controversial: The study also found no significant improvement in efforts to wean people off antidepressants. The proportion of long-term users who were put on a lower dose remained constant over the decade, at 17.9% in 2014 compared to 17.8% in 2023.
Professor Libby Roughead, a co-author and Director of the Quality Use of Medicines and Pharmacy Research Centre at UniSA, notes that this lack of movement suggests that deprescribing strategies are not being routinely implemented in clinical practice. "Given the increase in long-term use, especially among young people, this is an area that requires urgent attention," she emphasizes.
Researchers point to several factors driving this trend. These include a rise in mental health issues among young people, increasing rates of psychological distress in general, the impact of the COVID-19 pandemic, and difficulties accessing psychological therapies.
With mental health demands at an all-time high, the authors advocate for a more balanced approach. This involves ensuring antidepressants are used appropriately and that patients receive adequate support to reduce or discontinue treatment when the clinical need has passed.
"Australia needs a stronger framework for safely tapering antidepressants, along with better access to psychological care," Professor Roughead asserts.
Associate Professor Andrew Andrade, another UniSA co-author, suggests that emerging technologies, such as predictive analytics and clinical decision-support tools, could help clinicians identify when deprescribing is appropriate. "Clinicians need stronger support systems to safely deprescribe antidepressants," he says. "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 study, titled 'Increasing Prevalence or Long-Term Antidepressant Use in Australia,' is published in Pharmacoepidemiology and Drug Safety. DOI: 10.1002/pds.70267
What do you think? Are you surprised by these findings? Do you think more needs to be done to support safe antidepressant use and deprescribing strategies? Share your thoughts in the comments below!
