Anti-depressant pill-popping may be ineffective

The fact that psychiatrists are calling for a national review into the overprescription of antidepressant drugs shows all is far from well with Australians’ mental health and wellbeing. One in seven of the population is taking selective serotonin reuptake inhibitors, which are prescribed to treat depression. Aside from the $635m cost to the Pharmaceutical Benefits Scheme, psychiatrists are concerned that hundreds of thousands of people may be on the medications unnecessarily. Withdrawal symptoms after stopping the pills can be so severe, health editor Natasha Robinson reports, that patients can find themselves stuck on the medication for years.

More than 32 million prescriptions for SSRIs were issued in 2021, three-quarters of them by GPs, with the rate of prescriptions doubling in the past decade. The average duration of treatment is four years, despite clinical guidelines typically recommending the drugs be taken for six to 12 months, or up to two years for patients at risk of relapse. Psychiatrists are calling for “deprescribing” pilot schemes and clinical trials under way in Queensland and Victoria to be broadened into a national program.

Patients should be warned of potential side-effects, the risk of dependence and that the medications may be no more effective than exercise, psychotherapy or even a placebo, as the specialists insist. Evidence is growing in medical literature that side-effects can intensify the longer patients are on the drugs, and can be long-lasting. Symptoms upon coming off the drugs can be even more intense than the original anxiety or depression that prompted them to be prescribed in the first place.

Deprescribing SSRIs has became a feature of treating depression and mental health problems in the UK since a national review two years ago. And specialists in Australia, for good reason, want the approach replicated here. The review in Britain was prompted by the research of Australian psychiatrist Mark Horowitz, who works in London.

Based on personal experience, Dr Horowitz wrote recently: “When I tried to come off this antidepressant over four months I received a very abrupt education into antidepressant withdrawal symptoms. I experienced insomnia, panic attacks, dizziness, anxiety and low mood. This was nothing like the Woody Allen-level neurosis that had led me to start them in the first place – and I had experienced nothing like it before.’’

The 14 per cent of Australians on SSRIs are part of a larger picture of widespread medical intervention in the lives of increasing numbers of people, from a young age onwards. One in nine boys aged five to seven and one in 20 girls are in the National Disability Insurance Scheme, mainly for autism and developmental problems. And diabetes drug Ozempic, widely used for weight loss, has soared in popularity, with 858,460 PBS-subsidised prescriptions issued this year, ​compared with 186,260 last year.