Approximately one in seven Australians uses antidepressants, with over 3.5 million prescriptions filled in 2021–22. This high prescription rate is despite clinical guidelines recommending antidepressants primarily for severe depression and anxiety.
The increasing trend in antidepressant prescriptions since 2013 is attributed to over-prescription. The pharmaceutical industry's aggressive marketing of SSRIs in the 1990s, including tactics like paying "key opinion leaders" to promote them, contributed to their widespread use.
The majority of antidepressants are prescribed by general practitioners (GPs), sometimes as a first-line treatment for mild depression, which goes against clinical guidelines. They are also prescribed to patients experiencing distress without a psychiatric diagnosis, such as those coping with personal challenges like terminal illness or a cancer diagnosis.
Several factors contribute to antidepressant use when unnecessary. Busy GPs may find it a convenient solution to complex problems, and patients may request them based on positive experiences from acquaintances or a desire to improve mental health.
Antidepressants are often misconceived as correcting chemical imbalances causing depression, but they are primarily emotional and sexual numbing agents, sometimes having sedating or energizing effects. While beneficial for some, they can cause adverse effects like insomnia, restlessness, nausea, weight gain, and persistent sexual dysfunction.
Most experts recommend specific prescribing regimens for antidepressants, ranging from months to two years. However, many patients either discontinue them within weeks due to adverse effects or continue using them indefinitely, contributing to the rise in long-term use.
Withdrawal symptoms, often mistaken for a relapse, can discourage individuals from discontinuing antidepressants. These symptoms can be severe and include "brain zaps," dizziness, restlessness, vertigo, and vomiting. Gradual tapering, guided by recent guidelines, is essential to avoid withdrawal symptoms.
The emphasis on antidepressants highlights the need to address the social determinants of mental health. Mental distress often stems from factors like poverty, unemployment, poor housing, and family violence, rather than individual problems.
Overprescription also reflects the medicalization of distress, where diagnoses like depression and anxiety are often descriptions without clear explanations. Each individual's distress has a unique meaning, and while there may be a medical cause, it often lies in personal struggles with emotions, relationships, or difficult life events.
To address the fundamental problem of overprescribing, improving GPs' support, resources, and evidence on the limited benefits of antidepressants is crucial. GPs should also discuss potential adverse effects and safe discontinuation strategies with patients.
Ultimately, addressing social inequality and changing community attitudes toward distress are essential steps to comprehensively tackle the problem of antidepressant overprescription.