Maudsley

• Around one in seven Australians take antidepressants; more than 3.5 million of us had them dispensed in 2021–22.
• Guidelines mostly recommend antidepressants for more severe depression and anxiety but not as first-line treatment for less severe depression.
• So why are so many Australians taking antidepressants and why are prescriptions rising?

Enter the antidepressant ‘blockbusters’

• In the 1990s, pharmaceutical companies heavily promoted new selective serotonin reuptake inhibitors (SSRI) antidepressants, including Prozac (fluoxetine), Zoloft (sertraline) and Lexapro (escitalopram).
• These drugs were thought to be less dangerous in overdoses and seemed to have fewer side effects than the tricyclic antidepressants they replaced.
• Pharmaceutical companies marketed SSRIs energetically and often exaggerated their benefits, including by paying “key opinion leaders” – high-status clinicians to promote them.

Why are antidepressants prescribed?

• GPs also prescribe antidepressants to patients experiencing distress but who don’t have a psychiatric diagnosis.
• Another, who cried when informed she had breast cancer, was immediately offered a prescription for antidepressants.

• Most patients believe antidepressants restore a chemical imbalance that underpins depression.
• Antidepressants are emotional (and sexual) numbing agents – sometimes sedating, sometimes energising.
• Around half of users have impaired sexual function and for some, this sexual dysfunction persists after stopping antidepressants.

How long do people take antidepressants?

• Around half of patients who start antidepressants don’t like them and stop within weeks.
• Of those who do take them for months, many continue to use them indefinitely, often for many years.
• Read more:
  Antidepressants can cause withdrawal symptoms – here’s what you need to know

We need to adjust how we view mental distress

• Overprescribing antidepressants is a symptom of our lack of attention to the social determinants of mental health.
• GPs also need to ensure they discuss with their patients the potential adverse effects of antidepressants, and when and how to safely stop them.
• But the fundamental problem is social and can only be properly addressed by meaningfully addressing inequality and changing community attitudes to distress.

Jon Jureidini receives research funding from MMRF. He is affiliated with Critical Psychiatry Network Australasia.