Bold truth: Australia is seeing a sustained rise in long-term antidepressant use, with the steepest growth among youths aged 10–24. And this trend is prompting serious questions about prescribing practices and guideline adherence.
A new study led by researchers from the University of South Australia analyzed PBS dispensing data for over 300,000 antidepressant users from 2014 to 2023. Published in Pharmacoepidemiology and Drug Safety, the study is described as the most comprehensive of its kind to date. It finds that 45% of young people on antidepressants remain on them for more than 12 months, with a notable portion continuing into or beyond two years.
Across all age groups, long-term use—defined as continuous use for more than 12 months—has climbed markedly, though the surge is most pronounced among younger Australians. Lead author Dr. Lasantha Ranwala notes this marks a significant shift in how antidepressants are used in Australia and raises concerns about potential overprescribing and deviations from guidelines that advocate re-evaluating medication after 6–12 months.
“Not only are more people starting antidepressants, but they are staying on them for longer,” Dr. Ranwala observes. He points out that this is particularly troubling for younger patients, where guideline-based care typically prioritizes psychological therapies as the first-line treatment.
Nationally, long-term antidepressant use rose from 66 to nearly 85 users per 1,000 people between 2014 and 2022, then leveled off slightly in 2023. Throughout the study period, women consistently exhibited higher usage than men.
Dr. Ranwala cautions that while antidepressants can be vital for moderate to severe depression, extended use can raise the risk of side effects and complicate withdrawal. “Withdrawal symptoms are frequently mistaken for a relapse of the underlying condition, which can prolong treatment unnecessarily,” he explains.
The researchers also observed little progress in efforts to reduce reliance on antidepressants. The share of long-term users who were prescribed a lower dose remained almost unchanged—from 17.9% in 2014 to 17.8% in 2023—suggesting that deprescribing strategies are not routinely integrated into practice, according to co-author Professor Libby Roughead, Director of the Quality Use of Medicines and Pharmacy Research Centre.
With prolonged use especially common among younger people, Prof Roughead emphasizes the urgent need to address deprescribing more actively. Several contributing factors are highlighted, including rising mental health challenges among youth, broader increases in psychological distress, the lingering effects of the COVID-19 era, and barriers to timely access to psychological therapies.
The authors advocate for a more balanced approach that safeguards appropriate antidepressant use while ensuring robust support for patients to taper or discontinue when clinically appropriate. “Australia needs a stronger framework for safe tapering and better access to psychological care,” Prof Roughead asserts.
Emerging tools may help clinicians navigate deprescribing. Associate Professor Andrew Andrade suggests that predictive analytics and clinical decision-support systems could flag patients who are good candidates for tapering and help coordinate access to non-pharmacological treatments, providing clear guidance for clinicians and patients throughout a gradual dose-reduction process.
The study, titled “Increasing Prevalence or Long-Term Antidepressant Use in Australia,” appears in Pharmacoepidemiology and Drug Safety (DOI: 10.1002/pds.70267).
Would this shift in long-term antidepressant use change how you view treatment strategies for younger individuals, and what experiences or concerns would you bring to the discussion in the comments?
