About one in seven Australians take antidepressants; more than 3.5 million by us distributed them in 2021–22. This is one of the highest Prescription rates of antidepressants in the world.
The guidelines mainly recommend antidepressants for more severe depression and worry but not as a first-line treatment for less severe depression. Less often, antidepressants can be prescribed for conditions such as chronic pain and migraine.
However, prescription rates continue to rise. Between 2013 and 2021, the rate of antidepressant prescriptions in Australia is steadily increasing by 4.5% annually. So why are so many Australians taking antidepressants and why are prescriptions increasing?
Evidence shows they are overprescribed. So how did we get here?
Enter the ‘blockbusters’ antidepressants
In the 1990s, pharmaceutical companies strongly promoted new antidepressants selective serotonin reuptake inhibitors (SSRIs), including Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram);
These drugs were thought to be less dangerous in overdose, and they seemed to be fewer side effects from the tricyclic antidepressants they replaced.
Drug companies aggressively marketed SSRIs and often exaggerated their benefits, including paying “key opinion leaders” – high level clinicians to promote them. This caused substantial development at the market.
Read more: We need new rules to define who is sick. Step 1: remove vested interests
SSRIs made billions of dollars for their manufacturers when they were patented. While they are now relatively cheap, they still prove themselves profitable due to high prescription levels.
Why are antidepressants prescribed?
The majority (85%) of antidepressants are prescribed to general practice. Some are prescribed for more severe depression and anxiety. But unlike clinical guidelines, GPs too set as first-line treatment for less severe depression.
Doctors also prescribe antidepressants for patients who experience distress but do not have a psychiatric diagnosis. A friend dealing with her husband’s terminal illness, for example, was encouraged to take antidepressants by her longtime physician, even though her caregiving capacity had not diminished. Another, who cried when she was told she had breast cancer, was immediately prescribed anti-depressants.
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There are several reasons why someone might take antidepressants when they don’t need them. A busy physician may be looking for a convenient solution to a complex and sometimes intractable problem. Other times, patients ask for a prescription. They may be encouraged by one good acquaintance experience or looking for other ways improve their mental health.
Most patients believe that antidepressants restore a chemical imbalance that underpins depression. This is it’s not true. Antidepressants are emotional (and sexual) numbing agents – sometimes calming, sometimes energizing. These effects suit some people, for example, if their emotions are too raw or they lack energy.
Read more: The chemical imbalance theory of depression is dead, but that doesn’t mean antidepressants don’t work
For others, they come with me troubling side effects such as insomnia, restlessness, nausea, weight gain. About half of users have impaired sexual function and for some this sexual dysfunction persists after stopping antidepressants.
How long do people take antidepressants?
Most experts and Guidelines recommend specific antidepressant prescription regimens, ranging from months to two years.
However, most antidepressants are consumed by two categories of people. About half of patients who start antidepressants don’t like them either stop within weeks. Of those who take them for months, many continue to use them indefinitely, often for many years. Long term use (beyond 12 months) accounts for much of the increase in antidepressant prescribing.
Some people try to stop taking antidepressants but are prevented from doing so withdrawal symptoms. Withdrawal symptoms – including “strokes”, dizziness, restlessness, vertigo and vomiting – can cause significant discomfort, reduced work function and relationship breakdown.
In 14 studies that looked at antidepressant withdrawal, about 50% of users experienced withdrawal symptoms when you come off antidepressants, which can be mistaken for a recurrence of the original problem. We conduct a overview to better understand the Australian experience of antidepressant withdrawal.
Antidepressants should not be stopped abruptly but gradually reduced, with smaller and smaller doses. Its recent Australian release Maudsley imprint instructions provides guidance on the complex regimens required to taper antidepressants.
Read more: Antidepressants can cause withdrawal symptoms – here’s what you need to know
We need to adjust how we view mental distress
The over-prescription of antidepressants is a symptom of our lack of attention to social determinants of mental health. It’s depressing to be poor (especially when your neighbors seem rich), unemployed or in a terrible workplace, poorly housed or fearful of domestic violence. It is a mistake to locate the problem in the individual when it belongs to society.
Overprescribing is also a symptom of the medicalization of discomfort. Most depression and anxiety diagnoses are descriptions masquerading as explanations. For each distressed person who fits the pattern of anxiety or depression, the meaning of their presentation is different. There may be a medical explanation, but more often than not, meaning can be found in the person’s struggle with difficult emotions, relationships, and other life circumstances, such as terrible disappointments or grief.
Physicians’ overprescribing reflects the pressures they face from workloads, unrealistic expectations of their ability, and misinformation from pharmaceutical companies and key opinion leaders. They need better support, resources and evidence about the limited ones benefits of antidepressants.
GPs should also ensure that they discuss with their patients the potential side effects of antidepressants and when and how to stop them safely.
But the fundamental problem is social and can only be properly addressed by effectively addressing inequality and changing community attitudes towards distress.
