Long-term antidepressant use is on the rise in Australia, with the largest increase among young people aged 10 to 24. According to a new study from the University of South Australia, the number of young people who have been using these medications for more than a year has more than doubled in the last decade. The researchers examined Pharmaceutical Benefits Scheme dispensing data from over 300,000 antidepressant users between 2014 and 2023, making this the most extensive study of its kind. 

According to the data, 45 per cent of adolescent antidepressant users continue to take their medicine for more than 12 months, and many for far over two years. Long-term use, defined by the study as taking antidepressants for more than a year, has climbed across all age categories, but it is much more prominent among younger Australians. 

Dr Lasantha Ranwala, the study's lead author, said the findings indicate a shift in how antidepressants are used, raising concerns about whether prescribing trends fit with therapeutic criteria. "Not only are more people taking antidepressants, but once they start, they are staying on them for longer," the psychiatrist claims. Guidelines typically advocate revisiting the need for medication every six to twelve months, and for younger people, psychological therapies are generally advised as the primary line of management. 

The data reveal that long-term use increased from 66 to nearly 85 users per 1000 individuals between 2014 and 2022, before levelling off slightly in 2023. Throughout the decade, women consistently reported higher use than males. 

Dr Ranwala points out that, while antidepressants can help individuals with moderate to severe depression, taking them for an extended period of time can present new issues. "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," the psychiatrist notes. Withdrawal, he adds, is sometimes misinterpreted as a return to the initial disease, resulting in prolonged treatment cycles. 

The report also reveals a plateau in efforts to lower doses over time. Only 17.9 per cent of long-term users were prescribed lower doses in 2014, compared to 17.8 per cent in 2023. Professor Libby Roughead, co-author, expresses concern over the poor development. "This lack of progress indicates that deprescribing methods are not being used consistently in clinical practice. Given the rise in long-term use, particularly among young people, this is an issue that deserves immediate attention." 

Researchers attribute the growth to a variety of variables, including poor mental health among young people, increased levels of psychological discomfort, the influence of the COVID-19 pandemic, and limited access to talking therapies. 

The authors advocate for a more balanced strategy that improves access to non-drug therapy and ensures safe tapering when medication is no longer required. "Australia needs a stronger framework for safely tapering antidepressants, along with better access to psychological care," Prof. Roughead says. 

According to co-author Associate Professor Andrew Andrade, technology has the potential to significantly improve safe deprescribing. "Clinicians need stronger support systems to safely deprescribe antidepressants," the psychiatrist claims. "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."