Australia’s sun-drenched, laid-back lifestyle belies the fact that it is one of the world’s highest users of antidepressant drugs, with young people being the fastest-growing category for the drugs.
More than three million (or 1 in 7) Australians take antidepressants every day and more than 32 million antidepressant prescriptions are filled each year.
On a per capita basis, this usage ranks Australia behind only Iceland, which has 19-hour winter nights commonly associated with depressive seasonal affective disorder, and the US.
Prescription rates have doubled in the last 10 years, while the start of the Covid pandemic saw a further increase in prescriptions of 15 percent.
Covid has also accelerated the use of antidepressants by young people (10-17 years old) and women in particular.
Australians lead the world when it comes to taking antidepressants and this is rising particularly fast among young women (file image)
A study from the University of NSW found that Covid caused an increase in antidepressant use that “was greater among women than men, and greater among young women than among other age groups.”
This suggested “an increased mental health burden in populations already on a trajectory of increased antidepressant use before the pandemic.”
A major concern with antidepressants is the uncertainty and difficulty of coming off.
Guidelines generally recommend that antidepressants be taken for up to 6 to 12 months after improvement, but this can be extended up to two years for people at risk of relapse.
The average amount of time Australians take antidepressants has lengthened, now averaging four years.
Australian clinical psychiatrist Dr. Mark Horowitz has experienced firsthand the difficulty of coming off antidepressants
Long-term use of antidepressants can cause weight gain, sleep disturbances, emotional numbing, constipation or diarrhea, sexual dysfunction, and low blood sodium levels.
There may also be a debilitating sense of dependency and addiction that undermines alternative ways of coping.
However, coming off antidepressants can be very challenging both physically and emotionally.
In 2021, a major study by the medical research body Cochrane Australia looked at methods of withdrawing from antidepressants.
For London-based Australian clinical psychiatrist Dr. Mark Horowitz, one of the study authors, the difficulty of coming off antidepressants is something he can personally testify to.
“I am one of hundreds of thousands of people who have experienced long, difficult and agonizing battles coming off long-term antidepressants due to the severity of the withdrawal effects,” he said.
More than two million antidepressant prescriptions are dispensed each year in Australia (file image)
What makes withdrawal from antidepressant medications particularly tricky is that common symptoms such as insomnia, low mood, anxiety, and changes in appetite could be considered a relapse in the condition that prompted the initial prescription.
“The difficulty of distinguishing between withdrawal symptoms and relapse presents a real challenge for patients, clinicians, and researchers alike,” said Dr. Horowitz.
He said it can often lead to inappropriate continuation of antidepressant medication, which is most often prescribed by GPs in Australia.
Worryingly, a survey of antidepressant users found that between one-third and one-half of them had no clear clinical assessment of why they were taking them or a plan to stop.
University of Queensland emeritus professor of general practice Mieke van Driel said robust research is lacking on the best ways to stop taking antidepressants.
Cochrane lead author Mieke van Driel, professor emeritus of general medicine at the University of Queensland, said that in her general medical practice she had seen “first-hand the difficulties many patients have in coming off antidepressants.”
“While much is known about the increasing global acceptance of antidepressant medications, there is little high-quality evidence on safe and effective approaches to stopping treatment.”
Other common withdrawal effects are flu-like symptoms such as headaches, chills, dizziness, body aches, nausea or sweating, gastrointestinal problems, and sensations similar to electric shocks or a racing noise in the head.
Dr. Horowitz said the alphabeth she had been taking antidepressants for 18 years after first taking them in her 20s and found the experience of coming off them ‘scary and unnerving’.
“I had panic attacks, couldn’t sleep…symptoms I’ve never experienced before stopping these medications,” he said.
Dr. Horowitz said there was such a paucity of solid research and experience on the subject that he was forced to consult unofficial sources online.
“Instead, I found that the most useful information was on peer support sites where people who had withdrawn from antidepressants were forced to try to become lay experts,” he said.
Stopping antidepressants cold turkey is not recommended.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines recommend that antidepressants be tapered off slowly, but concede that “there is insufficient evidence to suggest the best regimen for this.”
Dr. Horowitz said that because antidepressants have such a powerful effect on the brain, they must be withdrawn gradually, over weeks or even years.
“We know that the slower you come off an antidepressant, the less intolerable the experience will be,” he says.
Dr. Horowitz says his personal fight to quit drugs paid off.
“For me, coming off antidepressants, while it’s been a difficult process, has been transformative: I’ve improved tiredness, memory and concentration problems that I thought for a long time were due to other conditions,” he said.