Why are so many Australians taking antidepressants?

Round one in seven Australians take antidepressants; greater than 3.5 million of us had them allotted in 2021–22. That is one of many highest antidepressant prescribing charges on the planet.

Pointers principally suggest antidepressants for extra extreme melancholy and nervousness however not as first-line remedy for much less extreme melancholy. Much less generally, antidepressants could also be prescribed for circumstances comparable to power ache and migraine.

But prescription charges proceed to extend. Between 2013 and 2021, the antidepressant prescription charge in Australia steadily elevated by 4.5% per 12 months. So why are so many Australians taking antidepressants and why are prescriptions rising?

The proof suggests they’re over-prescribed. So how did we get right here?

Enter the antidepressant ‘blockbusters’

Within the Nineteen Nineties, pharmaceutical firms closely promoted new selective serotonin reuptake inhibitor (SSRI) antidepressants, together with Prozac (fluoxetine), Zoloft (sertraline) and Lexapro (escitalopram).

These medication had been regarded as much less harmful in overdoses and appeared to have fewer unwanted side effects than the tricyclic antidepressants they changed.

Pharmaceutical firms marketed SSRIs energetically and infrequently exaggerated their advantages, together with by paying “key opinion leaders” – high-status clinicians to advertise them. This prompted substantial progress available in the market.

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SSRIs earned billions of {dollars} for his or her producers when on patent. Whereas now comparatively low cost, they nonetheless show profitable due to excessive prescribing ranges.

Why are antidepressants prescribed?

The bulk (85%) of antidepressants are prescribed in basic observe. Some are prescribed for extra extreme melancholy and nervousness. However opposite to scientific pointers, GPs additionally prescribe them as a first-line remedy for much less extreme melancholy.

GPs additionally prescribe antidepressants to sufferers experiencing misery however who don’t have a psychiatric analysis. A pal coping with her husband’s terminal sickness, for instance, was inspired to take antidepressants by her long-term GP, despite the fact that her caring capability wasn’t impaired. One other, who cried when knowledgeable she had breast most cancers, was instantly supplied a prescription for antidepressants.

GP writes a script
Typically sufferers who don’t have a psychiatric analysis obtain antidepressants.
Stephen Barnes/Shutterstock

There are a number of the explanation why somebody could take antidepressants once they’re not wanted. A busy GP may be on the lookout for a handy answer to a posh and generally intractable downside. Different instances, sufferers request a prescription. They might be inspired by an acquaintance’s good expertise or on the lookout for different methods to enhance their psychological well being.

Most sufferers imagine antidepressants restore a chemical imbalance that underpins melancholy. That is not true. Antidepressants are emotional (and sexual) numbing brokers – generally sedating, generally energising. These results swimsuit some individuals, for instance, if their feelings are too uncooked or they lack vitality.

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For others, they arrive with troubling unwanted side effects comparable to insomnia, restlessness, nausea, weight acquire. Round half of customers have impaired sexual operate and for some, this sexual dysfunction persists after stopping antidepressants.

How lengthy do individuals take antidepressants?

Most consultants and pointers suggest particular prescribing regimes of antidepressants, various from months to 2 years.

Nonetheless, most antidepressants are consumed by two classes of individuals. Round half of sufferers who begin antidepressants don’t like them and cease inside weeks. Of those that do take them for months, many proceed to make use of them indefinitely, typically for a few years. Lengthy-term use (past 12 months) is driving a lot of the rise in antidepressant prescribing.

Some individuals attempt to cease taking antidepressants however are prevented from doing so by withdrawal signs. Withdrawal signs – together with “mind zaps”, dizziness, restlessness, vertigo and vomiting – may cause important misery, impaired work operate and relationship breakdown.

Throughout 14 research that examined antidepressant withdrawal, round 50% of customers skilled withdrawal signs when coming off antidepressants, which might be mistaken for recurrence of the preliminary downside. We’re conducting a survey to raised perceive the expertise in Australia of withdrawing from antidepressants.

Antidepressants shouldn’t be stopped abruptly however step by step tapered off, with smaller and smaller doses. The latest launch in Australia of the Maudsley Deprescribing Pointers supplies steerage for the complicated regimes required for the tapering of antidepressants.

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Antidepressants may cause withdrawal signs – right here’s what it’s essential know

We have to modify how we view psychological misery

Overprescribing antidepressants is a symptom of our lack of consideration to the social determinants of psychological well being. It’s miserable to be poor (particularly when your neighbours appear wealthy), unemployed or in an terrible office, inadequately housed or frightened of household violence. It’s incorrect to find the issue within the particular person when it belongs to society.

Overprescribing can also be symptomatic of medicalisation of misery. Most diagnoses of melancholy and nervousness are descriptions masquerading as explanations. For every distressed one that matches the sample of tension or melancholy, the that means of their presentation is completely different. There could also be a medical rationalization, however most frequently that means could also be discovered within the individual’s wrestle with troublesome emotions, their relationships and different life circumstances comparable to horrible disappointments or grief.

GPs’ overprescribing displays the pressures they expertise from workload, unrealistic expectations of their capability and misinformation from pharmaceutical firms and key opinion leaders. They want higher help, assets and proof concerning the restricted advantages of antidepressants.

GPs additionally want to make sure they talk about with their sufferers the potential adversarial results of antidepressants, and when and methods to safely cease them.

However the basic downside is social and might solely be correctly addressed by meaningfully addressing inequality and altering neighborhood attitudes to misery.


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