Antidepressants are widely used for panic disorders, anxiety, and depression. In many countries, these medications are also prescribed off label. Guidelines generally suggest treatment for 6-12 months. However, long-term use of these medications beyond one year has been increasing in Australia, Italy, the UK, and Sweden. Stopping these medicines can lead to the risk of withdrawal symptoms. Â These symptoms may be mistaken for relapses. This often contributes to restarting the treatment. Several factors influence prolonged use, including concerns about long-term safety, risk of relapse, patient stress, and limited follow-up. Additionally, factors such as polytherapy, older age, and female sex are associated with long-term use. In Australia, evidence on long-term use of antidepressants remains unexplored. This gap was recently addressed by a study published in Pharmacoepidemiology and Drug Safety.
In this retrospective observational study, antidepressant use from 2014 to 2023 was analyzed using a 10% sample from the Australian Pharmaceutical Benefits Scheme (PBS). This study included dispensing and demographic information for patients aged ≥10 years. This data excluded the mostly public hospital inpatient and private purchases. Children <10 years were excluded from this study. Antidepressants were detected using the World Health Organization’s Anatomical Therapeutic Chemical (ATC) codes, with bupropion and amitriptyline removed due to common non-depression indications. New users, long-term users, and apparent dose reduction attempts, as well as short-term users (≤1 year), were identified based on drug dispensing patterns. Statistical analysis determined the age-group patterns, prevalence, long-term use, and incidence. A 60-day gap was used to define continuous treatment.
The prevalence of antidepressant use rose from 107.7 to 10.6 per 1000 population from 2014 to 2023, peaking from 2019 to 2022. It slightly declined to 128.8 per 1000 people during 2023. Incidence increased from 29.4 (2014) to 32.4 (2021), then fell to 29.4 (2023). Incident users formed only 22.9% of prevalent users in 2023. Â From 2014 to 2022, long-term antidepressant use rose from 66.1/1000 to 85.6/1000, with higher rates in females.
Age-stratified analysis demonstrated that all age groups showed increases, with the largest in the 10-24 years age group (110%), followed by the 25-39 years age group (37%). In 2023, 76.7% of users aged 75 or older were long-term users. Among 10-24-year-olds, long-term use rose from 33.4% (2014) to 45.1% (2023), and SSRI use increased from 68.8% (95% CI 67.5–70.0) to 79.5% (95% CI 78.9–80.1). Average treatment duration increased across ages, peaking at 10-24 years, rising by 56% to 2.17 years in 2023. Apparent dose-reduction attempts remained stable between 17.90% (2014) and 17.83% (2023).
This study’s limitations include assumptions in defining long-term use, a lack of detailed dosage data, potential overestimation of dose reduction, and treatment duration estimates based on prevalence-incidence ratios due to data censoring.
This study concluded that long-term antidepressant use is rising across all age groups, with the sharpest increase in patients aged 10-24 years. Longer treatment durations and minimal dose-reduction efforts suggest possible overprescription and inadequate deprescribing. Strengthening mental health care needs effective deprescribing strategies and greater integration of technological, psychological, and social interventions.
References: Ranwala RADLMK, Roughead EE, Calabretto J-P, Andrade AQ. Increasing prevalence of long-term antidepressant use in Australia: a retrospective observational study. Pharmacoepidemiol Drug Saf. 2025;34(11):e70267. doi:10.1002/pds.70267
