Findings from more than 300,000 PBS records show long-term prescribing rising steadily while dose-reduction practices stagnate, raising concerns over side effects, withdrawal and escalating health-system costs.
Australian antidepressant users are remaining on treatment far beyond recommended time frames, new research has found.
And the evidence also shows that long-term use has surged across all age groups and more than doubled among young people, highlighting a widening gap between clinical guidelines and real-world practice.
Long term use is defined as taking antidepressants continuously for more than 12 months.
In 2014 there were 135,144 long-term antidepressant users in Australia – by 2023 that number had jumped to 199,040, the researchers reported.
The highest percentage of long‐term users, 76.7%, was observed in the 75 years and above age group in 2023. However, the 10 to 24-year age group showed the largest relative increase in the percentage of long‐term users, rising from 33.4% in 2014 to 45.1% in 2023, an increase of 35%.
The study from the University of South Australia retrospectively analysed PBS dispensing data from more than 300,000 antidepressant users between 2014 and 2023. The PBS data excludes most of the medications dispensed to inpatients in public hospitals and private purchases.
The de‐identified dataset includes individual information (gender, birth year) and dispensing details (prescription and dispensing dates, medicine Anatomical Therapeutic Chemical (ATC) code and quantity of supplies). Children aged under 10 years were excluded from the analysis as antidepressants are not generally indicated in this age group, the researchers noted.
Findings have been published in Pharmacoepidemiology and Drug Safety.
The researchers found that 45% of young antidepressant users remained on treatment for longer than 12 months, and many continued beyond two years, despite guidelines recommending a review of therapy after six to 12 months.
Lead author Dr Lasantha Ranwala said the data reflected a significant shift in prescribing patterns and highlights the need for closer monitoring of long-term use.
“Not only are more people taking antidepressants, but once they start, they are staying on them for longer,” he said.
Dr Ranwala noted that while antidepressants remained integral in managing moderate to severe depression, guideline-recommended first-line psychological therapies for young people are not being prioritised, and prolonged pharmacotherapy may introduce unnecessary risks.
Across the broader population, long-term antidepressant use rose from 66 to nearly 85 users per 1000 people between 2014 and 2022, with only a slight stabilisation in 2023. Women consistently recorded higher use than men throughout the study period.
The authors warned that prolonged antidepressant treatment increases the likelihood of side effects and complicated cessation.
“While antidepressants play a role in managing moderate to severe depression, prolonged use can increase the risk of side effects and make withdrawal more difficult,” said Dr Ranwala.
“Withdrawal symptoms are often misinterpreted as a return of the underlying condition, which can further extend treatment, exacerbating the problem.”
Further to this, the researchers also noted that the prolonged utilisation of antidepressants raised significant clinical concerns regarding the balance between therapeutic benefits and potential adverse effects.
“At the healthcare system level, prolonged and potentially unwanted antidepressant use may lead to increased pharmaceutical expenditure,” they wrote.
Despite rising long-term use, deprescribing efforts appear stagnant. Only around 18% of long-term users were placed on lower doses in both 2014 and 2023, showing no improvement in dose-reduction practices.
UniSA co-author Professor Libby Roughead, director of the Quality Use of Medicines and Pharmacy Research Centre, said this indicated that deprescribing strategies were still not routinely embedded in clinical care, despite their importance, particularly for younger patients.
“Given the increase in long-term use, especially among young people, this is an area that requires urgent attention,” said Professor Roughead.
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The researchers attributed the trend to a range of factors, including increased psychological distress among young Australians, limited access to psychological therapies and the sustained mental health impacts of the covid pandemic.
They called for a more balanced approach that includes better support for clinicians and patients when tapering is appropriate, as well as expanded access to non-pharmacological interventions.
“Australia needs a stronger framework for safely tapering antidepressants, along with better access to psychological care,” said Professor Roughead.
UniSA co-author, Associate Professor Andrew Andrade said emerging clinical decision-support technologies may play a growing role in identifying suitable candidates for deprescribing and offering structured guidance for slow, safe dose reduction.
“Clinicians need stronger support systems to safely deprescribe antidepressants,” said Professor Andrade.
“Smart technologies can help identify patients who are good candidates for tapering, coordinate timely access to non-pharmacological treatments, and provide clear, step-by-step guidance to clinicians and patients throughout the slow dose-reduction process.”
