Around one in seven Australians take antidepressants; more than 3.5 million of us had them dispensed in 2021–22. This is one of the highest antidepressant prescribing rates in the world.
Guidelines mostly recommend antidepressants for more severe depression and anxiety but not as first-line treatment for less severe depression. Less commonly, antidepressants may be prescribed for conditions such as chronic pain and migraine.
Yet prescription rates continue to increase. Between 2013 and 2021, the antidepressant prescription rate in Australia steadily increased by 4.5% per year. So why are so many Australians taking antidepressants and why are prescriptions rising?
The evidence suggests they’re over-prescribed. So how did we get here?
Enter the antidepressant ‘blockbusters’
In the 1990s, pharmaceutical companies heavily promoted new selective serotonin reuptake inhibitor (SSRI) antidepressants, including Prozac (fluoxetine), Zoloft (sertraline) and Lexapro (escitalopram).
These drugs were thought to be less dangerous in overdoses and seemed to have fewer side effects than the tricyclic antidepressants they replaced.
Pharmaceutical companies marketed SSRIs energetically and often exaggerated their benefits, including by paying “key opinion leaders”—high-status clinicians to promote them. This prompted substantial growth in the market.
SSRIs earned billions of dollars for their manufacturers when on patent. While now relatively cheap, they still prove lucrative because of high prescribing levels.
Why are antidepressants prescribed?
The majority (85%) of antidepressants are prescribed in general practice. Some are prescribed for more severe depression and anxiety. But contrary to clinical guidelines, GPs also prescribe them as a first-line treatment for less severe depression.
GPs also prescribe antidepressants to patients experiencing distress but who don’t have a psychiatric diagnosis. A friend dealing with her husband’s terminal illness, for example, was encouraged to take antidepressants by her long-term GP, even though her caring capacity wasn’t impaired. Another, who cried when informed she had breast cancer, was immediately offered a prescription for antidepressants.
There are several reasons why someone may take antidepressants when they’re not needed. A busy GP might be looking for a convenient solution to a complex and sometimes intractable problem. Other times, patients request a prescription. They may be encouraged by an acquaintance’s good experience or looking for other ways to improve their mental health.
Most patients believe antidepressants restore a chemical imbalance that underpins depression. This is not true. Antidepressants are emotional (and sexual) numbing agents—sometimes sedating, sometimes energizing. Those effects suit some people, for example, if their emotions are too raw or they lack energy.
For others, they come with troubling side effects such as insomnia, restlessness, nausea, weight gain. Around half of users have impaired sexual function and for some, this sexual dysfunction persists after stopping antidepressants.
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Why are so many Australians taking antidepressants? (2024, February 9)
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