Time to Rethink Long-Term Antidepressant Use

Antidepressant use in Australia on the rise

Australia’s antidepressant use has quietly, steadily grown to become among the highest in the world. One in seven Australians (nearly 4 million people) now take antidepressants daily, with use rising year on year. However, the data reveals a telling truth: the surge in prescriptions is not being driven by a growing number of new users, but by people staying on antidepressants long-term, often without ongoing review or re-evaluation of their clinical need.

This pattern, now widely documented in both Australian and international studies, presents a clear challenge to clinical practice. While antidepressants undoubtedly play a valuable role in treating moderate to severe depression and anxiety, long-term use without follow-up has become the norm rather than the exception. But is this an issue? It certainly raises important questions about safety, informed consent, and whether current prescribing practices truly serve patients’ long-term wellbeing, not to mention the need for this intervention long-term. 

Prescriptions with no review

Recent research from the ongoing RELEASE trial in general practice settings around Australia found that half of those prescribed antidepressants had been using them for more than two years. Yet clinical guidelines, including those endorsed by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), typically recommend a treatment duration of 6 to 12 months for a single episode of major depression, followed by re-evaluation and, where appropriate, tapering. Counteracting these guidelines is the fact that many mental health concerns are reported to be underreported for many years, often seeing delayed diagnoses, and the pharmacological intervention requiring 3-6 months for effects to take place.

What they are reporting is that instead of cycling off treatment after symptom resolution or remission, many patients remain on antidepressants indefinitely. This may be due to a perceived need, fear of relapse, lack of follow-up, or confusion around withdrawal symptoms, often mistaken for return of illness. In most cases, the decision to continue is not revisited, and medication reviews are potentially absent from the equation. Is this a bad thing? 

Harms of prolonged antidepressant use

Although generally well-tolerated in the short term, antidepressants are not benign when used chronically. Patients may experience a range of adverse effects, including fatigue, weight gain, sexual dysfunction (which may be irreversible), and changes in emotional regularity. These side effects are underrecognised and underreported in both consultations and clinical trials.

In older adults, the risks are particularly pronounced. Long-term antidepressant use in people aged 65 years and older has been associated with increased rates of falls, hyponatraemia, fractures, and even mortality. Alarmingly, more than a quarter of Australians over 75 are currently prescribed antidepressants.

The benefits of long-term treatment are less clear. Evidence supporting extended use primarily comes from relapse prevention trials, which often stop antidepressants abruptly in control arms. This methodological flaw means that withdrawal symptoms which are common and sometimes severe, are misclassified as relapse, inflating the apparent benefit of continuation.

Disparity of decision-making

Perhaps most concerning is the erosion of shared decision-making in long-term antidepressant use. While initial prescriptions may be made collaboratively with the patient, psychiatry involvement, general practitioner and in consultation with psychology input, the years that follow often see little engagement with the risks, side effects, or alternatives. Many patients report never having discussed stopping their medication with a healthcare provider. Others attempt to taper, only to be misdiagnosed with relapse when withdrawal symptoms emerge. The principle of informed consent becomes meaningless if patients are not routinely presented with their options. Without discussion of the long-term risks, or access to safe and structured tapering plans, patients are effectively locked into pharmacological treatment they may no longer need or want.

This is particularly troubling given that women are prescribed antidepressants at 1.5 times the rate of men, and people aged over 65 at twice the rate of younger adults. The intersection of gender, age, and medication inertia deserves more scrutiny, and more tailored solutions.

Access and alternatives

To its credit, Australia’s primary care system has improved access to mental health care through expanded mental health care plans and Medicare-subsidised psychology sessions. However, ‘demand’ does not equate to ‘supply’ or sustained therapeutic engagement.

For many patients, the ten subsidised sessions per calendar year are insufficient to support the type of long-term, non-pharmacological intervention that may truly address the root causes of distress. Waiting lists for psychologists, especially in regional and low-income areas, remain long. Socioeconomic factors, logistical barriers, and cultural stigma continue to limit uptake. As a result, antidepressants become a default, and an affordable, accessible, and quick intervention when there is urgency and time-sensitivity. In a system where more time-intensive, holistic care remains out of reach, this is of course a reasonable alternative. GPs are often left with limited options when managing distress, grief, social isolation, trauma or existential suffering; all of which can manifest as depressive symptoms but are not best treated with medication alone.

Resourcing solutions before changing guidelines

There is growing consensus that the current antidepressant prescribing paradigm must shift. However, calls to update clinical guidelines must be matched with realistic implementation pathways. Telling GPs to deprescribe without giving them the tools to support patients doing so, such as access to tapering resources, support for withdrawal symptom management, and access to multidisciplinary care, will only increase frustration and fragmentation.

On a positive note; some progress is being made. The Royal Australian College of General Practitioners (RACGP) has endorsed the Maudsley Deprescribing Guidelines, which recommend a slow, hyperbolic taper for safer discontinuation of antidepressants. The RELEASE trial is also evaluating structured tapering plans in general practice. However, these initiatives remain underutilised and underfunded. Guideline reform must also reflect the lived experiences of patients. The RANZCP guidelines have been criticised for their limited inclusion of consumer voices and lack of representation from general practice, despite GPs issuing 92% of antidepressant prescriptions in Australia. 

If Australia is serious about improving mental health outcomes, it must acknowledge the limitations of its current antidepressant prescribing practices. This does not mean vilifying antidepressants, which remain an important tool for many, but it does mean reassessing how they are used, for how long, and with what support.

Wallis, K.A., King, A. and Moncrieff, J. (2025) Antidepressant prescribing in Australian Primary Care: Time to reevaluate, The Medical Journal of Australia. Available at: https://www.mja.com.au/journal/2025/222/9/antidepressant-prescribing-australian-primary-care-time-reevaluate.