Increasing Prevalence of Long-Term Antidepressant Use in Australia: A Retrospective Observational Study

Australia, with a population of 27.5 million and a good medical system, has often been a testing ground for drugs before they are released onto larger markets like the US or EU. A recent study investigated long-­term antidepressant use (maintaining continuous use for at least 365 days, allowing for dispensing gaps up to 60 days) in Australian users from 2014 to 2023.¹

A retrospective analysis was then conducted using a 10% sample of data from the Australian Pharmaceutical Benefits Scheme (PBS) (including patients aged over 10) who had been dispensed PBS-­listed antidepressants from January 2014 to December 2023.

Findings

This study found that the prevalence of long-­term antidepressant use increased from 66.1 to 84.6 per 1000 population. Long-­term antidepressant use and treatment duration increased steadily across all age groups in Australia from 2014 to 2023. A significant finding was that the 10 to 24 age group showed the highest relative increase (110%) in long-­term use and treatment duration. The percentage of long-­term users (35%) with apparent dose reductions showed minimal change over time. There was a large increase in off-label use, notably for sleep and pain. The authors recommended that long-­term antidepressant use may reduce the risk-benefit profile due to the increased likelihood of withdrawal symptoms and higher incidence of adverse effects.

Discussion

Antidepressants are intended for treatment of moderate to severe depression, anxiety, and panic. Since they were first released, there have been questions over their long-term use and when to terminate treatment. More recent has been the recognition of rebound symptoms when ceasing. This is often mistaken for relapse, leading to continued use, rather than a managed deprescription.

The increase in use in the 10- to 24-year-old group in the study is concerning. Do adolescents and young adults now have more psychiatric disorders, or does this reflect the growing tendency to medicalize all problems of life, rather than seek out the underlying causes? Unfortunately, it is hard to avoid concluding that it is the latter. Dealing with the causes of depression takes longer and it is easier to write a prescription, rather than engage in more lengthy psychological treatment.

Other uses of antidepressants not mentioned in the study would certainly occur, notably their use for attention-deficit/hyperactivity disorder. Pain clinics routinely put patients on low-dose antidepressants, notably amitriptyline, but good studies showing their benefits are lacking. The off-label use of antidepressants for sleep problems is troubling. It suggests that proper histories are not taken, excluding other manageable causes, leading to unnecessary adverse effects.

Concluding Thoughts

The lessons of this study reiterate frequent concerns about promiscuous use of antidepressants, especially in younger age groups and its findings should be noted.

Dr Kaplan is a clinical associate professor in the School of Medicine at Western Sydney University, in Sydney, Australia.

Reference

1. Ranwala RADLMK, Roughead EE, Calabretto JP, Andrade AQ. Increasing prevalence of long-term antidepressant use in Australia: a retrospective observational study. Pharmacoepidemiol Drug Saf. 2025;34(11):e70267.